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(Circulation. 2001;104:I-148.)
© 2001 American Heart Association, Inc.

Surgery for Congenital Heart Disease

Factors Related to Pleural Effusions After Fontan Procedure in the Era of Fenestration

Raymond T. Fedderly, MD; Beth N. Whitstone, RN; Stephanie J. Frisbee, MSc; James S. Tweddell, MD; S. Bert Litwin, MD

Department of Pediatrics, Division of Cardiology (R.T.F., B.N.W.), Department of Quality and Outcomes Management (S.J.F.), and Department of Surgery, Division of Cardiothoracic Surgery (J.S.T., S.B.L.), Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee.

Correspondence to Raymond T. Fedderly, MD, Department of Pediatric Cardiology, Medical College of Wisconsin, 9000 W Wisconsin Ave MS 713, Milwaukee, WI 53226. E-mail fedderly{at}mcw.edu

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.

Key Words: Fontan procedure • heart defects, congenital • risk factors • viruses