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. 2023 Apr 24;9(1):20.
doi: 10.1186/s40981-023-00611-1.

Anesthetic management of cesarean hysterectomy using intra-aortic balloon occlusion in a patient with Fontan circulation and placenta increta: a case report

Eriko Ohsugi  1 , Rie Kato  2 , Yuki Hosokawa  2 , Katsunori Oe  2
Affiliations

Anesthetic management of cesarean hysterectomy using intra-aortic balloon occlusion in a patient with Fontan circulation and placenta increta: a case report

Eriko Ohsugi et al. JA Clin Rep. .

Abstract

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.

Keywords: Arterial pressure-based stroke volume; Fontan circulation; Intra-aortic balloon occlusion; Obstetric hemorrhage; Placenta accreta spectrum.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Circulatory flow in the current Fontan-palliated patient A without infrarenal IABO and B with IABO. A Venous blood flows back directly to the pulmonary artery without passing through the atrium and ventricle. B When infrarenal IABO is applied, cardiac output is assumed to be reduced. IABO, intra-aortic balloon occlusion
Fig. 2
Fig. 2
Trends in hemodynamic parameters during anesthesia. Minute ventilation is constant during surgery. Further, FiO2 is maintained at 0.67 throughout anesthesia, and abdominal pressure is not applied at delivery of the baby. Oxytocin is not administered after delivery. HR, heart rate, SpO2, percutaneous arterial oxygen saturation, ABP, arterial blood pressure, ETCO2, end-tidal carbon dioxide partial pressure, ScvO2, central venous oxygen saturation, apCI, arterial pressure-based cardiac index, CVP, central venous pressure, SVV, stroke volume variation, apSV, arterial pressure-based stroke volume. X, anesthesia start/finish, ◎, operation start/finish, B, baby delivery, T, intubation, E, extubation, IABO, intra-aortic balloon occlusion, H, hysterectomy, R1, insertion of the IABO sheath, R2, insertion of the transesophageal echocardiography probe
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