///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Management of Labor and Delivery of a Patient With a Single Ventricle Status Post Fontan Procedure

Abstract Number: FC10-105
Abstract Type: Case Report Case Series

Michael T Bangert M.D.1 ; Kristen Vanderhoef M.D.2; Adrienne Warrick M.D.3

Single ventricle disease is a rare disorder occurring approximately 4-8 per 10,000 births and in 7.7% of congenital heart disease diagnosed at childhood (1). This case involves a 28 year-old G2P0010 who presented for induction of labor at 36 weeks and zero days. She has a past medical history of single ventricle of right ventricular morphology, transposition of great vessels with severe valvular and subvalvular pulmonic stenosis, recurrent reentrant atrial tachycardia status post direct current cardioversion and antiarrhythmic therapy currently on amiodarone. Her past surgical history includes modified Blalock, Glenn, modified Fontan with subsequent revision of the atrial septal defect, and ligation of superior vena cava to left atrium vessels. She is status post ablation of two intraatrial reentrant tachycardia circuits and placement of a single chamber intraatrial pacer for antitachycardia pacing due to refractory intraatrial tachycardia. She was also on enoxaparin that was transitioned to heparin, and heparin was held prior to induction in order to follow ASRA guidelines for neuraxial anesthesia. A cardiology consult was obtained, and as recommended, she received a lumbar epidural for labor and delivered uneventfully with a vacuum assisted vaginal delivery in the obstetric operating room. Monitoring included standard ASA monitors with a portable vitals monitor including a continuous EKG and a right radial arterial blood pressure. Via her epidural catheter, she received 5 ml of lidocaine 1.5% with epinephrine 1:200,000 in divided doses immediately after catheter placement. An epidural infusion of bupivacaine 0.1% was started at 8 ml/hr. She later received boluses of 5 ml of lidocaine 2% once approximately one hour before and once immediately before transport to the OR for vaginal delivery. Management of patients with Fontan physiology includes balancing preload, afterload, pulmonary vascular resistance, and cardiac output. The physiological changes of pregnancy include an increase in preload, decrease in afterload, increase in heart rate, and an increase in blood volume (2). Whether a patient with Fontan physiology can handle these changes depends on whether the pulmonary vasculature and the single ventricle can handle the increased preload. For this patient, monitoring for dysrhythmias was also important, and management included continuation of antiarrythmic medications, continuous EKG and arterial blood pressure monitoring, and having emergency drugs immediately available.

SOAP 2019