Poster presentation

Background: Fontan procedure which is a staged surgical repair, has proven to increase survival rates greater than 90% in babies born with complex heart disease such as hypoplastic left heart syndrome, tricuspid atresia [1].Optimal anesthetic management with advanced hemodynamic monitoring while emphasizing on preload, pulmonary vascular resistance, contractility and afterload is imperative in the intraoperative period.Daunting insults of pneumoperitoneum must be mitigated by maintaining lower intra-abdominal pressures (<10 mmHg), minimal surgical time, adequate ventilation and optimal intravascular volume.Case Illustration: A 14-year-old boy 4 weeks after completion of Fontan procedure which was complicated with acute kidney injury and sepsis while recovering, presented with acute right hypochondriac pain.Laparoscopic interval cholecystectomy was planned after a diagnosis of acute cholecystitis.Intraoperative management was optimized to facilitate the Fontan circulation without jeopardizing the hemodynamic stability of this patient.Fontan circulation functions by passive flow of the systemic venous return to the pulmonary vasculature and then leading to the single ventricle to generate the systemic flow.Factors relevant to maintain a decent blood flow and an acceptable pressure difference between caval veins and the single ventricle were distinguished.This patient had an uneventful perioperative period and discharged on the 10th postoperative day with a plan to review. Conclusion:Anesthetic management of a patient with Fontan physiology coming for laparoscopic surgery is a challenging situation.Theoretical as well as analytical understanding of the fontal circulation and maintenance of near optimal preload, pulmonary vascular resistance, afterload and contractility are essential to accentuate successful outcomes.A multidisciplinary approach consists of cardiologists, pediatricians, intensivists, surgeons and anesthetists is mandatory to facilitate the perioperative care of this case.