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Anesthetic Implications of Extended Right Hepatectomy in a Patient with Fontan Physiology

Weyker, Paul David MD; Allen-John Webb, Christopher MD; Emond, Jean C. MD; Brentjens, Tricia E. MD; Johnston, Taylor A. MD

doi: 10.1213/XAA.0000000000000012
Case Reports: Case Report

Patients who have undergone complete cavopulmonary anastomosis, the Fontan procedure, have passive venous blood flow from the superior and inferior vena cava into the pulmonary circulation without passing through the right ventricle. Although this procedure is an effective means of palliation, the resultant chronically increased central venous pressure, leads to several types of hepatic dysfunction including chronic congestion, cardiac cirrhosis, and even hepatocellular carcinoma. In this case report, we describe a patient with Fontan-associated hepatocellular carcinoma who successfully underwent a right hepatectomy.

From the Department of Anesthesiology, Columbia University College of Physicians & Surgeons, New York, New York.

Paul David Weyker, MD, and Christopher Allen-John Webb, MD, are currently affiliated with Department of Anesthesiology & Perioperative Care, University of California San Francisco, San Francisco, California.

Accepted for publication October 8, 2013.

Funding: No funding.

This report was previously presented, in part, at the Columbia University Academic Evening.

The authors declare no conflicts of interest.

Address correspondence to Paul David Weyker, MD, Department of Anesthesiology, Columbia University College of Physicians & Surgeons, 622 West 168th St., PH5New York, NY 10032. Address e-mail to

© 2014 International Anesthesia Research Society