title: Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural effusions after the Fontan operation.
abstract: BACKGROUND
  We validated the clinical relevance of ventricular stiffness by examining surgical morbidity in children with univentricular hearts undergoing Fontan operation. We hypothesized that ventricular stiffness affects Fontan morbidity, particularly duration of pleural effusions.
  
  
  RESULTS
  Sixteen children with right ventricular (RV) (n =11) or left ventricular (LV) (n =5) dominance were studied intraoperatively at a median age of 3.3 years (1.8 to 5.1). Transesophageal long-axis echocardiograms and ventricular pressure by micromanometer provided end-diastolic pressure (P) area (A) relations during initiation and conclusion of cardiopulmonary bypass. Curve fitting to the equation P=alphae(betaA) defined the ventricular stiffness constant, beta. Changes in beta and clinical correlations were examined. Ventricular stiffness increased after bypass in patients with complete pre-bypass and post-bypass data (n =11, P=0.023, mixed models methodology). Pre-bypass beta correlated well with duration of chest tube (CT) drainage (r=0.90, n =16), net perioperative fluid balance (r=0.71, n=14), and length of stay (LOS) (r=0.81, n =16). CT duration and LOS also correlated significantly with post-bypass beta (r=0.77 for both, n=11), but insignificantly with preoperative catheterization pressures.
  
  
  CONCLUSIONS
  Intraoperative beta predicts duration of CT drainage, net perioperative fluid balance, and LOS after the Fontan operation. These observations could improve risk stratification and clinical management of children at high-risk undergoing the Fontan operation.
authors.affiliation: Department of Pediatrics, Columbia College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA.
authors.forename: Cara A
authors.initials: CA
authors.lastname: Garofalo
authors.forename: Santos E
authors.initials: SE
authors.lastname: Cabreriza
authors.forename: T Alexander
authors.initials: TA
authors.lastname: Quinn
authors.forename: Alan D
authors.initials: AD
authors.lastname: Weinberg
authors.forename: Beth F
authors.initials: BF
authors.lastname: Printz
authors.forename: Daphne T
authors.initials: DT
authors.lastname: Hsu
authors.forename: Jan M
authors.initials: JM
authors.lastname: Quaegebeur
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Mosca
authors.forename: Henry M
authors.initials: HM
authors.lastname: Spotnitz
mesh_terms: D015505:Chest Tubes; D002675:Child, Preschool; D003187:Compliance; D003971:Diastole; D017558:Elective Surgical Procedures; D005260:Female; D018729:Fontan Procedure; D006352:Heart Ventricles / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010996:Pleural Effusion / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance