Pleural effusions following the Fontan procedure.
OBJECTIVE
The Fontan procedure is the final common pathway in the surgical palliation of many single ventricle heart defects. Mortality has improved but morbidity remains significant. Pleural effusions continue to present challenges after this operation and account for increased length of stay and increased time with draining tube thoracostomies. This review examines recent publications addressing this problem.


RESULTS
Four papers in 2008-2009 addressed effusions after the Fontan procedure. Off-pump Fontan procedures did not decrease time until chest tube removal. Pulmonary vascular compliance, derived from an electrical circuit model, predicted chest tube indwelling time. A retrospective study identified mean pulmonary artery pressure as a risk factor for effusions lasting more than 14 days after the Fontan procedure. One prospective, randomized trial evaluated the effects of lisinopril on pleural effusions after the Fontan procedure. There was no difference in the length of pleural drainage between the two groups.


CONCLUSIONS
Pleural effusions after the Fontan procedure continue to be a challenge. The cause is likely multifactorial and could explain why the literature has no clear message. One randomized, prospective trial suggests that fenestration reduces effusions. Many other reviews report no benefit to fenestration. Sildenafil after the Fontan procedure should be studied in a randomized, prospective fashion.
Mascio
Christopher E
CE
Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky 40202, USA. cmascio@ucsamd.com
Austin
Erle H
EH
D000959:Antihypertensive Agents / Q000627:therapeutic use; D015505:Chest Tubes; D004322:Drainage; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000188:drug therapy; D017706:Lisinopril / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D010996:Pleural Effusion / Q000209:etiology* / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011687:Purines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D000959:Antihypertensive Agents; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D017706:Lisinopril