Perioperative Hemodynamics and Clinical Outcomes of Cesarean Delivery Under Neuraxial Anesthesia in Women with Fontan Circulation: A Single-Center Retrospective Cohort Study.

Authors

Tomoaki Miyake, Sho Masuda, Akito Tsukinaga, Kotaro Hizuka, Chizuko Aoki-Kamiya, Jun Yoshimatsu, Hideo Ohuchi, Kenji Yoshitani, Takuma Maeda

Published in

Journal of cardiothoracic and vascular anesthesia. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

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.
Single-center retrospective cohort study.
Tertiary referral center in Japan.
Women with Fontan circulation undergoing cesarean delivery (2009-2025).
Neuraxial anesthesia and cesarean delivery.
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.
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
Bibliographic data and abstract were imported from PubMed on 25 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.