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ANAESTHETIC MANAGEMENT IN PREGNANT WITH FONTAN PHYSOLOGY-CASE REPORT
 
An estimated 70,000 adult patients with Fontan physiology live worldwide, which is expected to double in 20 years. The Fontan procedure is performed as the final stage of palliation in patients with congenital heart disease with a single ventricle, such as tricuspid atresia, hypoplastic left heart syndrome, or atrioventricular duct defect. With the development of surgical methods and the improvement of long-term results of operations, women with congenital heart disease can become pregnant until reproductive age. Perioperative management of this challenging population requires careful, multidisciplinary, and wide-ranging management. A 23-year-old woman patient was admitted to the obstetrics clinic at the age of 36 weeks and 2 days for g2p0a1y0 (gravida 2, parity 0, abortus 1 , living 0) planned caesarean section. In the preoperative evaluation of the patient, it was learnt that the Blalock Taussing Shunt (pulmonary artery and subclavian anostoly) and the Fontan operation were performed 20 years ago with the diagnosis of respiratory distress, tricuspid atresia, main pulmonary atresia, and avsd at birth. Echocardiography revealed normal ventricular contraction, single AV valve, and minimal-1 AV valve failure. 4.5 m/s pansystolic current velocity was obtained. The patient who underwent epidural anaesthesia and analgesia was managed with invasive artery monitoring, as well as hemodynamic parameters of CO (cardiac output) and SVRI (systemic vascular resistance index). Patient-controlled analgesia was administered with epidural bupivacaine for postoperative pain. A total of 1000 ml of intravenous crystalloid, 100 ml of 5% dextrose, and 50 ml of intravenous colloid solution were administered to the patient. The patient was transferred to the intensive care unit for close follow-up of cardiac status and fluid balance. After staying in the intensive care unit for 1 day, the patient was transferred to the service and discharged home on the third postoperative day without any problems. In high-risk pregnant women with Fontan physiology, regional techniques, close hemodynamic monitoring, and fluid monitoring are critical to minimise complications. ORCID NO: 0000-0002-7837-7655

Anahtar Kelimeler: Fontan,Pregnant,Cardiac Anesthesia