J Cardiothorac Vasc Anesth. 2026 Jul 4:S1053-0770(26)00561-6. doi: 10.1053/j.jvca.2026.07.004. Online ahead of print.
ABSTRACT
OBJECTIVES: Cesarean delivery in women with Fontan circulation poses significant risks of hemodynamic instability. We aimed to characterize perioperative hemodynamic fluctuations and describe short-term maternal and neonatal outcomes in this population.
DESIGN: Single-center retrospective cohort study.
SETTING: Tertiary referral center in Japan.
PARTICIPANTS: Women with Fontan circulation undergoing cesarean delivery (2009-2025).
INTERVENTIONS: Neuraxial anesthesia and cesarean delivery.
MEASUREMENTS AND MAIN RESULTS: Twelve deliveries (11 women) were analyzed. Median gestational age was 35.5 weeks; all patients were New York Heart Association class I at the initial visit. After neuraxial anesthesia, central venous pressure (CVP) fell from 17.0 to 11.0 mmHg (-6.0 mmHg [-8.5 to -4.0], p = 0.006), and systolic blood pressure fell from 129 to 107 mmHg (-24.5 mmHg [-30.5 to -17.5], p = 0.003). With vasopressor support, clinically significant hypotension was avoided in 11 of 12 deliveries. Immediately after delivery, systolic blood pressure decreased in all cases (estimated paired difference, -21.0 mmHg; 95% CI, -25.0 to -17.0; p = 0.003), whereas CVP showed no consistent change (estimated paired difference, 0.0 mmHg; 95% CI, -7.5 to 2.0; p = 0.96). No new-onset heart failure or arrhythmias requiring treatment occurred intraoperatively, though postoperative arrhythmias developed in 25% of deliveries.
CONCLUSION: In this cohort of carefully selected patients with Fontan circulation, cesarean delivery was associated with manageable hemodynamic fluctuations and acceptable short-term outcomes when continuous CVP monitoring and timely pharmacologic interventions were implemented. These data may inform multidisciplinary peripartum management in this high-risk population.
PMID:42498615 | DOI:10.1053/j.jvca.2026.07.004