Section 2 Fontan Therapies

*Advances in Complex Valvular Disease*

2018;**122**(6):1028-1035

Heart, Lung & Circulation.

Surgery. 2019;**26**(8):737743

2019;**29**(5):729-741

The American Journal of Cardiology.

[70] Takagi H, Hari Y, Kawai N, et al. Meta-analysis and meta-regression of transcatheter aortic valve implantation for pure native aortic regurgitation.

[71] Luo Y, Lulu L, Jun S, et al. Early clinical results of transcatheter aortic valve replacement with J-valve for high risk pure aortic regurgitation. Chinese Journal of Thoracic and Cardiovascular

**102**

**105**

**Chapter 6**

**Abstract**

**1. Introduction**

conditions [1].

noncardiac procedures.

Physiopathological Approach of

Surgery for the Anesthesiologist

*Yamile Muñoz, María José Sáenz and Renzo Cifuentes*

**Keywords:** congenital heart disease (CHD), chronic heart failure (CHF), single ventricle (SV), Fontan procedure, Fontan physiology, Fontan failure, pulmonary vascular resistance (PVR), systemic vascular resistance (SVR),

preoperative evaluation, intraoperative management

tive risk than their counterparts with normal hearts.

total cavopulmonary connection (TCPC), cardiac output (CO), cardiac index (CI),

Univentricular patients in the stage of Fontan palliation have a higher periopera-

The diagnosis and treatment of children with congenital heart disease (CHD)

remained stable; the natural history of the lesions and overall survival rate have also changed notably. Advances made in surgical procedures and techniques, in concert with improvements in diagnosis, anesthesia practices, intensive care, and medical treatments, have transformed many of these fatal lesions into manageable chronic

Many more of these patients are surviving with this physiology than could have

A normal biventricular cardiovascular system consists of a double circuit, pulmonary and systemic, connected in series and powered by a double pump. Many complex cardiac malformations are characterized by the existence of only one functional

been contemplated 30 years ago and nowadays they seek medical attention for other causes different from their cardiovascular conditions that require surgical

has improved significantly over the last decades. The incidence of CHD has

the Fontan Patient for Noncardiac

Since 1971, when Dr. Francis Fontan and collaborators described a surgical technique that restored pulmonary flow in patients with tricuspid atresia and despite the fact that it has had modifications over time, the impact on the survival of these patients has been notable. It is currently known as the Fontan procedure and is indicated to treat single ventricle congenital heart defects. Thanks to the great advances in the field of congenital heart surgery, as well as better pediatric cardiology and intensive care management, the survival of patients with congenital heart defects has increased significantly, among whom are patients with univentricular or single ventricle physiology. The objective of this chapter is to provide the anesthesiologist with useful and applicable concepts in the evaluation and perioperative management of patients with a Fontan repair, especially for noncardiac surgeries.
