Anesthetic Management of Emergency Cesarean Section in a Parturient with Fontan Circulation

Pregnancy in patients with Fontan circulation is rare and associated with significant maternal and fetal morbidity. Anesthetic management in such patients requires meticulous planning to maintain Fontan physiology, avoid increases in pulmonary vascular resistance, and ensure adequate preload. We report the successful anesthetic management of a 30-year-old primigravida with complex cyanotic congenital heart disease, including double-outlet right ventricle, large ventricular septal defect, and pulmonary atresia, who had undergone a fenestrated Fontan procedure. She presented for emergency lower segment cesarean section at 32 weeks of gestation due to acute fetal compromise. Despite severe right ventricular dysfunction and limited preoperative optimization, multidisciplinary planning and vigilant intraoperative management resulted in a favorable maternal and fetal outcome.