Further Perspectives on Anesthetic Management of Emergency Cesarean Delivery in a Parturient with Fontan Circulation

“Although pulse pressure variation is an established predictor of fluid responsiveness in carefully selected mechanically ventilated patients, its use has not been specifically validated in Fontan circulation and should be interpreted cautiously, where pulmonary blood flow is passive and ventricular preload depends primarily on transpulmonary flow rather than the conventional heart–lung interactions on which dynamic preload indices rely.”

“Similarly, reporting intraoperative ventilatory variables such as peak inspiratory pressure, plateau pressure, mean airway pressure, and driving pressure would be particularly informative because pulmonary blood flow in Fontan circulation is highly sensitive to increases in intrathoracic pressure, which may impair venous return and reduce cardiac output.”

“We read with great interest the case report by Pahwa et al. describing the anesthetic management of emergency cesarean delivery in a parturient with Fontan circulation. The authors should be congratulated for successfully managing a complicated case and for highlighting the importance of multidisciplinary care. We believe that several aspects of the perioperative management merit further clarification to enhance the physiological understanding and educational value of this instructive case.”