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

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.

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Repair of a traumatic subarachnoid-pleural fistula with the percutaneous injection of fibrin glue in a 2-year-old

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.5.peds15194 ◽

2016 ◽

Vol 17 (1) ◽

pp. 13-18 ◽

Cited By ~ 4

Author(s):

Jason K. Chu ◽

Brandon A. Miller ◽

Michael P. Bazylewicz ◽

John F. Holbrook ◽

Joshua J. Chern

Keyword(s):

Fibrin Glue ◽

Chest Tube ◽

Epidural Injection ◽

Dural Defect ◽

Percutaneous Injection ◽

Ct Guided ◽

First Line Therapy ◽

Tube Output ◽

Chest Tube Output ◽

Dural Defects

Subarachnoid-pleural fistulas (SPFs) are rare clinical entities that occur after severe thoracic trauma or iatrogenic injury during anterolateral approaches to the spine. Treatment of these fistulas often entails open repair of the dural defect. The authors present the case of an SPF in a 2-year-old female after a penetrating injury to the chest. The diagnosis of an SPF was suspected given the high chest tube output and was confirmed with a positive β2-transferrin test of the chest tube fluid, as well as visualization of dural defects on MRI. The dural defects were successfully repaired with CT-guided percutaneous epidural injection of fibrin glue alone. This case represents the youngest pediatric patient with a traumatic SPF to be treated percutaneously. This technique can be safely used in pediatric patients, offers several advantages over open surgical repair, and could be considered as an alternative first-line therapy for the obliteration of SPFs.

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Abstract 16822: Growth Curves Describing a Single Ventricle Population After Fontan Procedure

Circulation ◽

10.1161/circ.142.suppl_3.16822 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Bethany Runkel ◽

Vincent Staggs ◽

Chelsea Hosey Cojocari ◽

Jonathan B Wagner

Keyword(s):

Single Ventricle ◽

Multiple Stressors ◽

Pediatric Population ◽

Fontan Procedure ◽

Fontan Operation ◽

Growth Patterns ◽

Growth Charts ◽

Genetic Syndrome ◽

Adiposity Rebound ◽

Extracardiac Conduit

Introduction: Complex single ventricle congenital heart disease (CHD) patients are subject to multiple stressors early in life that affect somatic growth. Pre-Fontan growth patterns are well-described, but post-Fontan growth has not been extensively studied in the current era. We sought to describe post-Fontan growth patterns by creating sex-specific body mass index (BMI)-for-age curves. Hypothesis: There is no difference in the growth of post-Fontan pediatric patients when compared to published normative data. Methods: A single-center, preexisting database was retrospectively queried for all patients who underwent Fontan procedure between 2006 and 2018. Patients with a genetic syndrome, a primary endocrine disorder, or significant prematurity were excluded. BMI-for-age curves were created for both male and female patients using anthropometric data extracted from the electronic medical record. Curves were then visually compared with Centers for Disease Control and Prevention (CDC) growth charts. Results: Of 227 patients who underwent primary Fontan operation, 37 were excluded. Of the remaining 190 patients, 59% were male. All had an extracardiac conduit, half had right-ventricular dominant CHD, and 15% had a Fontan fenestration. Median age and weight at surgery were 3.9 years and 15 kilograms, respectively. BMI curves were similar in appearance to CDC BMI-for-age growth charts, with adiposity rebound at age 6. BMI increased more rapidly in teen boys compared with girls, and a total of five patients (2.6%) had BMI values greater than 25 kg/m 2 at 16 years of age. Conclusion: Post-Fontan patients at our institution demonstrate BMI-for-age patterns similar to those of the general population during childhood and early adolescence, with adiposity rebound occurring at a typical age. Though excess weight gain does not completely spare patients with single ventricle CHD, overweight status appears to be less common than in the general pediatric population.

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Risk of Renal Dysfunction after Less Invasive Multivessel Coronary Artery Bypass Grafting

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182614f80 ◽

2012 ◽

Vol 7 (3) ◽

pp. 180-186 ◽

Cited By ~ 1

Author(s):

Soroosh Kiani ◽

Alex K. Brown ◽

Dinesh J. Kurian ◽

Stanislav Henkin ◽

Mary M. Flynn ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Chest Tube ◽

Artery Bypass ◽

Bypass Grafting ◽

Off Pump ◽

Transfusion Requirements ◽

Tube Output ◽

Chest Tube Output

Objective Several centers have established that off-pump, multivessel coronary artery bypass grafting performed via a small thoracotomy (MVST) is feasible. However, this procedure can be challenging when posterolateral coronary targets need to be grafted. We hypothesized that use of cardiopulmonary bypass via peripheral access (MVST-PA) would improve outcomes compared with a completely off-pump approach (OP-MVST). Methods This was a prospective observational study of patients undergoing OP-MVST (n = 46) versus MVST-PA (n = 45) using bilateral internal mammary artery grafts onto the left anterior descending coronary artery and circumflex/right coronary artery distribution. Hemostasis was quantified by measuring platelet function (aggregometry), chest tube output, thrombolysis in myocardial infarction bleeding score (%hematocrit change at 24 hours), and transfusion requirements. The rate of mortality and major morbidity at 30 days was defined according to The Society of Thoracic Surgeons criteria. Estimated glomerular filtration rate (normalized to baseline levels) was determined daily until discharge. Results The OP-MVST versus MVST-PA groups had similar risk factors at baseline and risks of composite morbidity/mortality at 30 days. However, renal failure was significantly increased after OP-MVST (10.87 vs 0%, P = 0.05), and MVST-PA affected hemostasis as evidenced by inhibition of platelet function (latency to response on aggregometry, 29.9 vs 17.9 seconds; P = 0.04) and higher transfusion requirement (2.31 vs 0.85 units of red blood cells/patient, P = 0.04; 55.6% vs 34.8% transfused; P = 0.059). However, 24-hour chest tube output was similar (645 vs 750 mL; P = 0.53). Conclusions In comparison with a completely off-pump strategy, use of cardiopulmonary bypass to assist MVST reduced the risk of renal dysfunction with only modest tradeoffs in other morbidities, for example, altered coagulation and higher transfusion requirements. These data justify further study of the effect of MVST-PA on renal complications.

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Treatment of hepatic hydrothorax and reduction of chest tube output with octreotide

European Journal of Gastroenterology & Hepatology ◽

10.1097/00042737-200108000-00019 ◽

2001 ◽

Vol 13 (8) ◽

pp. 977-980 ◽

Cited By ~ 16

Author(s):

Rahel Pfammatter ◽

Christiana Quattropani ◽

Jürg Reichen ◽

Burkhard Göke ◽

Andreas C. C. Wagner

Keyword(s):

Chest Tube ◽

Hepatic Hydrothorax ◽

Tube Output ◽

Chest Tube Output

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Thoracotomy for blunt chest trauma: is chest tube output a useful criterion?

Acute Medicine & Surgery ◽

10.1002/ams2.148 ◽

2015 ◽

Vol 3 (2) ◽

pp. 81-85

Author(s):

Yasuaki Mizushima ◽

Shota Nakao ◽

Hiroaki Watanabe ◽

Tetsuya Matsuoka

Keyword(s):

Chest Tube ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Tube Output ◽

Chest Tube Output

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Postoperative complications following the Fontan procedure: the role of aprotinin

Perfusion ◽

10.1177/0267659111416877 ◽

2011 ◽

Vol 26 (6) ◽

pp. 529-535 ◽

Cited By ~ 3

Author(s):

D Klugman ◽

MT Donofrio ◽

D Zurakowski ◽

RA Jonas

Keyword(s):

Postoperative Complications ◽

Chest Tube ◽

Fontan Procedure ◽

Fontan Operation ◽

Multivariate Logistic Regression Analysis ◽

Chest Tube Drainage ◽

Control Group ◽

Tube Drainage ◽

Significant Difference ◽

Anti Inflammatory

Objective: To determine how the anti-inflammatory properties of aprotinin impact on postoperative complications in children undergoing the Fontan procedure. Methods: We included all patients between 14 months and 18 years (n=56) undergoing a Fontan operation at our institution between January 2005 and June 2009. The study group (n=29) included patients from January 2005 through December 2007 all of whom received aprotinin. The control group (n=27) included all patients from January 2008 through June 2009 who did not receive aprotinin. We reviewed all medical records and collected preoperative, intraoperative and postoperative data. Duration and volume of chest tube drainage were the primary outcome measures. Results: Of the 20% of patients who had postoperative arrhythmias, multivariate logistic regression analysis demonstrated only aprotinin was associated with significantly decreased postoperative arrhythmias ( P=0.01). Renal function and fenestration or Fontan thrombosis did not differ significantly; there was no statistically significant difference in volume or duration of chest tube drainage. Median duration of chest tube drainage was 7 days in the aprotinin group and 8 days for patients who did not receive aprotinin ( P=0.36). Conclusion: The anti-inflammatory properties of aprotinin may be protective against postoperative arrhythmias. Aprotinin does not confer increased risks of prolonged chest tube drainage, renal dysfunction or thrombosis in patients undergoing the Fontan procedure.

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