Management of cesarean section in a patient with Fontan circulation: a case report of dramatic reduction of maternal oxygen consumption after delivery.

Background: The anesthetic management of cesarean sections in Fontan-palliated parturients requires strict hemodynamic control. However, patient management with central venous oxygen saturation (ScvO) and oxygen consumption (VO) has never been reported.

Case Presentation: A 30-year-old woman, who had received a total cavopulmonary connection for tricuspid atresia, was planned to undergo cesarean section at 38 weeks' gestation. During combined spinal-epidural anesthesia, ScvO in addition to arterial pressure-based cardiac output (APCO) and central venous pressure (CVP) was monitored, and the change of VO was evaluated. After delivery, her APCO was almost unchanged. However, her ScvO increased dramatically from 42.1 to 67.3% and her CVP increased from 9 to 11 mm Hg. The calculated mean maternal VO changed from 443 to 295 mL/min.

Conclusions: In a cesarean section for a Fontan-palliated parturient, ScvO dramatically increased and maternal VO decreased by more than 25% after delivery.