Abstract
The number of post-Fontan patients is increasing with the improvement in diagnostic and therapeutic technologies. The number of post-Fontan patients, who have congenital non-cardiac disorders, such as respiratory or digestive disorders, is also increasing. These congenital non-cardiac disorders occasionally influence the plans for cardiac surgery, and these problems may deteriorate the pre- and post-operative respiratory and nutritional condition of patients. In pediatric surgery, to treat the above abnormalities, laparoscopic surgery has spread widely because of its less invasive and cosmetic advantages. After the Fontan procedure, passive pulmonary blood flow has to be driven by the trans-pulmonary pressure gradient. In laparoscopic surgery, the increased intra-abdominal pressure from pneumoperitoneum could effect Fontan circulation unfavorably. In addition, mechanical ventilation and the Trendelenburg position during laparoscopic surgery may deteriorate passive pulmonary circulation due to increased intra-thoracic pressure. Moreover, hypercapnia induced by the intra-abdominal CO2 gas may elevate pulmonary vascular resistance. So laparoscopic surgery is generally thought to be disadvantageous for post-Fontan patients. We had three cases of laparoscopic surgery after Fontan procedures. We prepared for the switch to open surgery, but laparoscopic surgery was accomplished uneventfully in all our cases. Sufficient discussion among related personnel enabled secure intra-operative management.
