Management of cesarean section in a patient with Fontan circulation: a case report of dramatic reduction of maternal oxygen consumption after delivery

Background: The anesthetic management of cesarean sections in Fontan-palliated parturients requires strict hemodynamic control. However, patient management with central venous oxygen saturation (ScvO₂) and oxygen consumption (VO₂) has never been reported. Case presentation: A 30-year-old woman, who had received a total cavopulmonary connection for tricuspid atresia, was planned to undergo cesarean section at 38 weeks’ gestation. During combined spinal-epidural anesthesia, ScvO₂ in addition to arterial pressure-based cardiac output (APCO) and central venous pressure (CVP) was monitored, and the change of VO₂ was evaluated. After delivery, her APCO was almost unchanged. However, her ScvO₂ increased dramatically from 42.1 to 67.3% and her CVP increased from 9 to 11 mm Hg. The calculated mean maternal VO₂ changed from 443 to 295 mL/min. Conclusions: In a cesarean section for a Fontan-palliated parturient, ScvO₂ dramatically increased and maternal VO₂ decreased by more than 25% after delivery.