Faculty Collaboration Database

Factors related to pleural effusions after Fontan procedure in the era of fenestration. Circulation 2001 Sep 18;104(12 Suppl 1):I148-51

Date

09/25/2001

Pubmed ID

11568047

DOI

10.1161/hc37t1.094817

Scopus ID

2-s2.0-0035909033 (requires institutional sign-in at Scopus site)   58 Citations

Abstract

BACKGROUND: Significant pleural effusions after the Fontan operation prolong hospital stay, may increase the risk of infection, and may necessitate a pleurodesis procedure.

METHODS AND RESULTS: From February 1991 to April 2000, 98 consecutive patients under the age of 18 years underwent the fenestrated Fontan procedure at Children's Hospital of Wisconsin. Ninety-four patients who survived at least 30 days after surgery were retrospectively evaluated for the following factors: age, ventricular morphology (right single ventricle, left single ventricle [RV/LV]), fenestration open (FO) or closed (FC) at end of operation, intracardiac Fontan (IF) or extracardiac Fontan (EF), days with chest tube output per day >5, 10, and/or 20 mL. kg(-1). d(-1) (CTO5, CTO10, and CTO20, respectively), need for pleurodesis, length of hospital stay (LOS), operation during winter respiratory viral season of November through March (ReVS+, ReVS-), and pre-Fontan mean pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR). In univariate analysis, the ReVS+ patients had prolonged LOS, greater chest tube output, and more pleurodesis (P<0.05), and PAP was related to CTO5 and CTO10 but not to CTO20 or LOS. No significant differences were found in LOS, CTO5, CTO10, CTO20, and need for pleurodesis between patients in RV/LV, FO/FC, IF/EF, or PVR groups. Patients <4 years of age had more instances of CTO20 (P<0.05). When we used ordinary least squares regression analysis with age, FO or FC, RV or LV, PAP, and ReVS+ or ReVS- to predict each of CTO5, CTO10, CTO20, and LOS, only ReVS+ or ReVS- and age were statistically significant in all models.

CONCLUSIONS: Use of the Fontan procedure during the respiratory viral season appeared to be related to significant, prolonged pleural effusions and longer hospitalizations.

Author List

Fedderly RT, Whitstone BN, Frisbee SJ, Tweddell JS, Litwin SB

Author

Raymond T. Fedderly MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Age Factors
Child
Child, Preschool
Female
Fontan Procedure
Heart Defects, Congenital
Humans
Infant
Length of Stay
Male
Pleural Effusion
Pleurodesis
Regression Analysis
Retrospective Studies
Seasons
Wisconsin