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Anesthesiology Research and Practice
Volume 2012, Article ID 475015, 5 pages
http://dx.doi.org/10.1155/2012/475015
Review Article

An Adult Patient with Fontan Physiology: A TEE Perspective

1Anesthesiology, Miller School of Medicine, Jackson Memorial Hospital, University of Miami, Miami, FL 33136, USA
2Anesthesiology, Memorial Regional Hospital East, Hollywood, FL 33136, USA
3Division of Cardiothoracic Surgery, Miller School of Medicine, Jackson Memorial Hospital, University of Miami, FL 33136, USA

Received 25 July 2011; Revised 31 October 2011; Accepted 14 November 2011

Academic Editor: Mukesh Tripathi

Copyright © 2012 Edward Gologorsky et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Fontan and Baudet described in 1971 the separation of the pulmonary and systemic circulations resulting in univentricular physiology. The evolution of the Fontan procedure, most notably the substitution of right atrial-to-pulmonary artery anastomosis with cavopulmonary connections, resulted in significantly improved late outcomes. Many patients survive well into adulthood and are able to lead productive lives. While ideally under medical care at specialized centers for adult congenital cardiac pathology, these patients may present to the outside hospitals for emergency surgery, electrophysiologic interventions, and pregnancy. This presentation presents a “train of thought,” linking the TEE images to the perioperative physiologic considerations faced by an anesthesiologist caring for a patient with Fontan circulation in the perioperative settings. Relevant effects of mechanical ventilation on pulmonary vascular resistance, pulmonary blood flow and cardiac preload, presence of coagulopathy and thromboembolic potential, danger of abrupt changes of systemic vascular resistance and systemic venous return are discussed.