One lung anaesthesia in a patient with Fontan circulation for video-assisted thoracoscopic lung resection

One lung anaesthesia in patients with Fontan circulation can be haemodynamically unsettling. Successful perioperative management requires a good understanding of the staged palliative correction, univentricular physiology, multiorgan function, one lung ventilation, and its reciprocal cardiorespiratory impacts. With the improvement of surgical palliation and supporting medical care, an increasing number of such patients will be attaining adulthood, and the clinicians will encounter them for non-cardiac surgery with higher frequency. Fontan circulation has important implications for the anaesthesiologist, as their interventions, especially during one lung anaesthesia, have profound effects on the Fontan physiology. Meticulous planning, preoperative evaluation, an experienced team of clinicians, and availability of an extracorporeal cardio-respiratory support facility are the prerequisites. We discuss in this case report the anaesthetic management in a young girl with univentricular heart syndrome palliated by Glenn and Fontan procedures in early life. She was posted for left upper lobectomy for a lung cavitary lesion with aspergilloma. The Fontan circulation physiology, impact of one lung ventilation and the importance of preservation of Fontan circulation, along with preparedness for heart failure, are discussed in this case report.