2024 FSA Podium and Poster Abstracts

P097: FONTAN PROCEDURE IN A JEHOVAH'S WITNESS WITH MALIGNANT HYPERTHERMIA
Erick Rodriguez; Joseph Dayan; Cameron Lambert; Amanda Saab; Jackson Memorial Hospital/UM

Introduction: This paper examines the Fontan procedure as a palliative approach for patients with single ventricle anatomy, focusing on a case involving a Jehovah’s Witness patient with a history of malignant hyperthermia (MH), highlighting the challenges and strategies of intraoperative management.

Case Report: We present a 5-year-old Jehovah’s Witness boy with MH and hypoplastic left heart syndrome, previously treated with a Norwood operation and a bidirectional Glenn shunt, now undergoing Fontan surgery. Preoperative preparation included achieving a hematocrit of 52. Anesthesia was initiated with ketamine and versed, and maintained with infusions of propofol, precedex, and sufentanil. Post-surgery, the patient was extubated, weaned off vasopressors, and given multiple fluid boluses to stabilize hemodynamics without the use of donor blood products, incurring a total blood loss of 150 mL and a closing hematocrit of 35. The patient's recovery in the pediatric intensive care unit was marked by ectopic atrial tachycardia and a high-output chylothorax, both managed successfully with medication and interventional procedures.

Conclusion: The case underscores the feasibility of conducting complex cardiovascular surgeries in Jehovah’s Witness patients by means of meticulous preoperative planning, intraoperative blood management, and multidisciplinary collaboration. Despite the inherent risks associated with the patient’s extensive surgical history and the restrictions on blood transfusion, the team achieved a favorable outcome through careful planning and execution.