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Sectio caesarea bei einer Patientin mit Fontan-Zirkulation

Anästhesiologisches Management

Patient with a Fontan circulation undergoing caesarean section

Anesthesiological management

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Zusammenfassung

Erwachsene mit angeborenen Herzfehlern stellen den Anästhesisten aufgrund einer Vielzahl an möglichen pathologischen Störungen, komplexen physiologischen Veränderungen und speziellen Therapien vor eine Herausforderung. Die Zahl dieser Patienten hat aufgrund des wachsenden Überlebens in den letzten Jahren stetig zugenommen, sodass auch die Häufigkeit schwangerer Patientinnen mit angeborenen Herzfehlern steigt. Der vorliegende Beitrag stellt die Grundlagen der Pathophysiologie und des anästhesiologischen Managements von schwangeren Patientinnen mit Fontan-Zirkulation anhand eines Falls vor, der durch eine Aortenisthmusstenose und eine atonische Uterusblutung verkompliziert wurde.

Abstract

Adults suffering from congenital heart diseases (CHD) represent a challenge to anesthesiologists because of the diverse pathologies, complex pathophysiology and special treatment strategies. Due to improved therapeutic options for CHD, patient quality of life and life expectancy is increasing, leaving them as a growing population including pregnant patients with CHD. This article presents the main principles of the pathophysiology and anesthesiological management of pregnant patients living with a Fontan circulation based on a case report, which was complicated by an aortic coarctation and atonic uterine hemorrhage.

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Danksagung

Besonderer Dank gilt der Patientin, die in die Erstellung und Veröffentlichung des Fallberichts einwilligte. Außerdem danken die Autoren Herrn PD Dr. J. Bauer, der die MRT-Bilder der Patientin zur Verfügung stellte, sowie dem Team der Kinder-Intensivstation des Universitätsklinikums Gießen und Marburg, Standort Gießen.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen, Sektion Kinderherzzentrum, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland

    E. Schneck, V. Mann, C. Körner, A. Jost & M.F. Müller

  2. Klinik für Kinderkardiologie, Kinderherzzentrum, Universitätsklinikum Gießen und Marburg, Standort Gießen, Feulgenstraße 10–12, 35392, Gießen, Deutschland

    J. Thul

  3. Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland

    J.B. Engel

Authors
  1. E. Schneck
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  2. V. Mann
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  3. C. Körner
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  4. A. Jost
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  6. J.B. Engel
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  7. M.F. Müller
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Corresponding author

Correspondence to E. Schneck.

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Interessenkonflikt

M. Müller hat Vortragshonorare der Fa. Linde AG Linde Healthcare, Orion Pharma GmbH und Sorin Deutschland GmbH erhalten. V. Mann Vortragshonorare der Fa. Orion Pharma GmbH erhalten. E. Schneck, C. Körner, A. Jost, J. Thul und J.B. Engel geben an, dass bei dem vorliegenden Beitrag kein Interessenkonflikt besteht.

Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Fall von nichtmündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Schneck, E., Mann, V., Körner, C. et al. Sectio caesarea bei einer Patientin mit Fontan-Zirkulation. Anaesthesist 64, 532–539 (2015). https://doi.org/10.1007/s00101-015-0047-1

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  • DOI: https://doi.org/10.1007/s00101-015-0047-1

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