TY - JOUR
T1 - Fontan's circulation with dextrocardia, recent pulmonary embolism, and inferior vena cava filter
T2 - Anesthetic challenges for urgent hysterectomy
AU - Singh, Preet Mohinder
AU - Borle, Anuradha
AU - Ramachandran, Rashmi
AU - Trikha, Anjan
AU - Goudra, Basavana Gouda
N1 - Publisher Copyright:
© 2016 Annals of Cardiac Anaesthesia.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Fontan's circulation is a unique challenge for the anesthesiologist. Venous pressure is the only source of blood flow for the pulmonary circulation. Patients with such circulation are extremely sensitive to progression of cyanosis (decreased pulmonary blood flow) or circulatory failure. Any major venous compression can compromise the pulmonary blood flow worsening cyanosis; simultaneously, an increased afterload can precipitate circulatory failure. We present a rare patient of surgically corrected Ivemark syndrome with Fontan's physiology with dextrocardia who developed a large uterine fibroid compressing inferior vena cava (IVC). As a result of compression, not only the pulmonary circulation was compromised but she also developed stasis-induced venous thrombosis in the lower limbs that lead to pulmonary embolism (PE) (increased afterload). In addition to oral anticoagulation an IVC filter was inserted to prevent ongoing recurrent PE. Further, to prevent both circulatory compromise and deep venous thrombosis an urgent myomectomy/hysterectomy was planned. In the present case, we discuss the issues involved in the anesthetic management of such patients and highlight the lacunae in the present guidelines for managing perioperative anticoagulation these situations.
AB - Fontan's circulation is a unique challenge for the anesthesiologist. Venous pressure is the only source of blood flow for the pulmonary circulation. Patients with such circulation are extremely sensitive to progression of cyanosis (decreased pulmonary blood flow) or circulatory failure. Any major venous compression can compromise the pulmonary blood flow worsening cyanosis; simultaneously, an increased afterload can precipitate circulatory failure. We present a rare patient of surgically corrected Ivemark syndrome with Fontan's physiology with dextrocardia who developed a large uterine fibroid compressing inferior vena cava (IVC). As a result of compression, not only the pulmonary circulation was compromised but she also developed stasis-induced venous thrombosis in the lower limbs that lead to pulmonary embolism (PE) (increased afterload). In addition to oral anticoagulation an IVC filter was inserted to prevent ongoing recurrent PE. Further, to prevent both circulatory compromise and deep venous thrombosis an urgent myomectomy/hysterectomy was planned. In the present case, we discuss the issues involved in the anesthetic management of such patients and highlight the lacunae in the present guidelines for managing perioperative anticoagulation these situations.
KW - Anticoagulation in Fontan's Circulation
KW - Fontan's circulation anesthesia
KW - Inferior vena cava filter noncardiac surgery
UR - http://www.scopus.com/inward/record.url?scp=84954531864&partnerID=8YFLogxK
U2 - 10.4103/0971-9784.173044
DO - 10.4103/0971-9784.173044
M3 - Article
C2 - 26750698
AN - SCOPUS:84954531864
SN - 0971-9784
VL - 19
SP - 177
EP - 181
JO - Annals of Cardiac Anaesthesia
JF - Annals of Cardiac Anaesthesia
IS - 1
ER -