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How to Make an Easy Case Hard: Managing an Adult with Fontan Physiology and Multisystem Organ Dysfunction for a Peritoneal Dialysis Catheter
Poster Title: How to Make an Easy Case Hard: Managing an Adult with Fontan Physiology and Multisystem Organ Dysfunction for a Peritoneal Dialysis Catheter
Submitted on 01 Jul 2018
Author(s): Victoria Melanson, M.D. and Vikas O'Reilly-Shah, M.D. Ph.D.
Affiliations: Emory University Department of Anesthesiology
This poster was presented at GSA
Poster Views: 613
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Abstract: Mr. X is a 30 year-old male weighing 64kg with a past medical history of single ventricle physiology, pulmonary hypertension, permanent pacemaker, horseshoe kidney in ESRD, and gout. He is currently under consideration for heart-liver-kidney transplant. Notably, two other referral centers did not feel he was an appropriate candidate for this transplant surgery given his complex history and anatomy. His cardiac history includes a Fontan repair (see below). Baseline SpO2 is 84% on room air. LVEF was 40% on TTE a week prior to surgery. Mr. X presents for a laparoscopic peritoneal dialysis catheter.Summary: Adult congenital heart disease is one of the fastest growing areas in adult cardiovascular medicine. Adults now outnumber children with CHD, accounting for 66% of the overall CHD population, and 60% of those with severe CHD. Surveys show that knowledge and comfort with adult CHD is low among anesthesiologists, even at specialized centers. Becoming familiar with management of adult CHD patients may greatly influence their outcomes, both perioperatively and long term.References: 1. Afilalo J, Therrien J, Pilote L, Ionescu-Ittu R, Martucci G, Marelli AJ. Geriatric congenital heart disease: burden of disease and predictors of mortality. J Am Coll Cardiol. 2011;58:1509-1515.
2. Marelli AJ, Ionescu-Ittu R, Mackie AS, Guo L, Dendukuri N, Kaouache M. Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation. 2014;130:749-756.
3. Krasuski RA and Bashore TM. Congenital Heart Disease Epidemiology in the United States. Circulation. 2016;134:110–113. DOI: 10.1161/CIRCULATIONAHA.116.023370
4. Marelli AJ, Mackie AS, Ionescu-Ittu R, Rahme E, Pilote L. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation. 2007;115:163- 172.
5. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J
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