Anesthetic Challenges in an Adult With Single-Ventricle Physiology and Incomplete Cavopulmonary Palliation Undergoing Noncardiac Interventions

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Single-ventricle physiology and incomplete cavopulmonary palliation (n=1). Intervention: General anesthesia. Primary outcome: Intraoperative management and maintenance of pulmonary blood flow.

Q: What does this research mean for the field?

Safe general anesthesia in adults with single-ventricle physiology and incomplete cavopulmonary palliation requires individualizing hemodynamic targets to minimize pulmonary vascular resistance, maintain cavopulmonary return, and preserve systemic perfusion. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Marine Bosquet; Mona Momeni; Christophe Vô; A PASQUET; Lancelot Marique; Cristina-Bianca Robu

doi:10.1016/j.jaccas.2026.110025

September 1, 2026JACC Case ReportsOpen Access

Anesthetic Challenges in an Adult With Single-Ventricle Physiology and Incomplete Cavopulmonary Palliation Undergoing Noncardiac Interventions

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Key result

Tailored anesthesia safely maintains pulmonary blood flow and systemic pressure in unpalliated single-ventricle physiology.

n=1

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND 4.0

Why the study?

There is little known about the anesthetic management of adult patients with single-ventricle physiology who have not undergone Fontan palliation.

Key Points

To describe the anesthetic considerations and hemodynamic management of an adult with unpalliated single-ventricle physiology undergoing noncardiac interventions.
Designed a multidisciplinary anesthetic plan for a 57-year-old male with pulmonary atresia, hypoplastic right heart, a right Glenn shunt, and a nonfunctional left Blalock-Taussig shunt (N=1).
Tailored intraoperative management to preserve right cavopulmonary venous return, avoid rises in pulmonary vascular resistance, and maintain left-sided systemic blood pressure and cardiac output.
Achieved stable pulmonary blood flow intraoperatively by preventing increases in pulmonary vascular resistance and maintaining systemic blood pressure.
Completed noncardiac interventions without adverse hemodynamic collapse through specialized collaboration with congenital cardiac anesthesiologists.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 57-year-old man with single-ventricle physiology and incomplete cavopulmonary palliation requiring general anesthesia for noncardiac procedures.

I

Intervention

General anesthesia for noncardiac procedures with tailored intraoperative management to maintain pulmonary blood flow and systemic blood pressure

Intraoperative management of adults with unpalliated single-ventricle physiology requires tailored anesthetic strategies to maintain pulmonary blood flow and systemic hemodynamics.

Implication

Informs perioperative strategies for rare adult congenital cases; leaves open generalizability and optimal protocols pending larger studies.

Abstract

BACKGROUND: Patients with single-ventricle physiology may present with complex forms rendering Fontan palliation impossible. CASE SUMMARY: After multidisciplinary discussion, a 57-year-old man with a history of a right Glenn shunt and a left nonfunctional modified Blalock-Taussig shunt and left aortopulmonary collaterals for pulmonary atresia, hypoplastic right heart and discontinuous pulmonary arteries, required general anesthesia for noncardiac procedures. Intraoperatively, pulmonary blood flow was maintained by avoiding any increase in pulmonary vascular resistance and any reduction in cavopulmonary venous return on the right side and by maintaining systemic blood pressure and adequate cardiac output on the left side. DISCUSSION: Although the long-term survival of patients with single-ventricle physiology without Fontan palliation is described, there is little known about their anesthetic management. TAKE-HOME MESSAGE: The intraoperative management of patients not palliated with the Fontan must be tailored to the existing anatomy and physiology and carried out in collaboration with congenital cardiac anesthesiologists.

Discussion

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Cite This Study

Bosquet et al. (2026) conducted a case report in Single-ventricle physiology and incomplete cavopulmonary palliation (n=1). General anesthesia was evaluated on Intraoperative management and maintenance of pulmonary blood flow. General anesthesia in a patient with single-ventricle physiology without Fontan palliation was successfully managed by tailoring care to maintain pulmonary blood flow and systemic blood pressure.

synapsesocial.com/papers/6ac19d70aeea5716e8c6c697 https://doi.org/10.1016/j.jaccas.2026.110025

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Anesthetic Challenges in an Adult With Single-Ventricle Physiology and Incomplete Cavopulmonary Palliation Undergoing Noncardiac Interventions

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Anesthetic Challenges in an Adult With Single-Ventricle Physiology and Incomplete Cavopulmonary Palliation Undergoing Noncardiac Interventions

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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