Key result
Infrarenal intra-aortic balloon occlusion successfully reduced intraoperative hemorrhage and maintained hemodynamic stability during a cesarean hysterectomy in a Fontan-palliated parturient with placenta increta.
Why the study?
In patients with Fontan circulation, hemorrhage can trigger life-threatening circulatory collapse due to strong preload dependence, and parturients with placenta accreta spectrum face a high risk of rapid and massive hemorrhage.
Case Report (n=1)
No
Intra-aortic balloon occlusion can be safely and effectively used to manage hemorrhage during cesarean hysterectomy in patients with Fontan circulation.
May warrant consideration in select Fontan cesarean hysterectomies; hypothesis-generating and requires prospective validation before broader use.
BACKGROUND: In patients with Fontan circulation, hemorrhage can cause life-threatening circulatory collapse, since Fontan circulation strongly depends on the preload. Furthermore, parturients with placenta accreta spectrum are at a high risk of rapid and massive hemorrhage. Herein, we report the case of an intra-aortic balloon occlusion used for a Fontan-palliated parturient with placenta increta with successful anesthetic management. CASE PRESENTATION: A 35-year-old-female with Fontan circulation diagnosed with placenta increta underwent a cesarean hysterectomy. The main goal during anesthetic management was to maintain sufficient preload. Infrarenal intra-aortic balloon occlusion was used to reduce intraoperative hemorrhage. The hemodynamic changes caused were well tolerated in this case. CONCLUSIONS: Intra-aortic balloon occlusion was used in a Fontan-palliated parturient with placenta increta with successful anesthetic management.
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Ohsugi et al. (2023) conducted a case report in Fontan circulation and placenta increta (n=1). Intra-aortic balloon occlusion was evaluated on Successful anesthetic management and hemodynamic stability. Infrarenal intra-aortic balloon occlusion successfully reduced intraoperative hemorrhage and maintained hemodynamic stability during a cesarean hysterectomy in a Fontan-palliated parturient with placenta increta.
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