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J Thorac Cardiovasc Surg 2004;128:799
© 2004 The American Association for Thoracic Surgery

Letter to the Editor

Pleural effusion and off-pump Fontan procedure

Ali Kubilay Korkut, MD, Gurkan Cetin, MD, Ilksen Soyler, MD, Emin Tireli, MD

Department of Cardiovascular Surgery, Istanbul University, Istanbul, Turkey

To the Editor:

We read with great interest the study by Gupta and colleagues1 "Risk Factors for Persistent Pleural Effusions After the Extracardiac Fontan Procedure," published in the June 2004 issue. Prolonged and excessive pleural drainage after the Fontan procedure is still the subject of debate. In their series of 100 patients, Gupta and colleagues1 reported prolonged duration of pleural drainage in 37% and increased volume of pleural drainage in 30% after the extracardiac Fontan operation.1 Lower preoperative oxygen saturation, presence of postoperative infection, smaller graft size, and longer cardiopulmonary bypass time were significantly associated with prolonged and increased pleural drainage.

We have used an off-pump technique for the bidirectional Glenn shunt and the extracardiac Fontan operation in patients without intracardiac anomalies.2,3 Prolonged pleural effusion was seen in 2 of 30 patients undergoing the bidirectional Glenn shunt (6.6%). Among 10 patients undergoing the off-pump extracardiac Fontan operation, only 1 (10%) had pleural drainage for longer than 2 weeks.

Lower preoperative oxygen saturation and increased preoperative pulmonary arterial pressure may be consequences of increased pulmonary vascular resistance. We surmise that cardiopulmonary bypass causes prolonged and excessive pleural effusion with increase of pulmonary vascular resistance and pulmonary arterial pressure. In patients with cyanosis, the blood flow of the major aortopulmonary collateral arteries may increase during cardiopulmonary bypass, which causes prolonged pleural effusion in some patients.

In conclusion, cardiopulmonary bypass is significantly associated with increased volume of pleural drainage after both the Glenn shunt and the extracardiac Fontan procedure. We believe that pleural drainage will decrease with the use of an off-pump technique.

[Response declined]


   References
Top
 References
 

  1. Gupta A, Daggett C, Behera S, Ferraro M, Wells W, Starnes V. Risk factors for persistent pleural effusions after the extracardiac Fontan procedure. J Thorac Cardiovasc Sur.2004;127:1664-1669.[Abstract/Free Full Text]
  2. Tireli E, Basaran M, Kafali E, Harmandar B, Camci E, Dayioglu E, et al. Perioperative comparison of different transient external shunt techniques in bidirectional cavo-pulmonary shunt. Eur J Cardiothorac Sur.2003;23:518-524.[Abstract/Free Full Text]
  3. Tireli E. Extracardiac Fontan operation without cardiopulmonary bypass: how to perform the anastomosis between inferior vena cava and conduit. Cardiovasc Sur.2003;11:225-227.



This article has been cited by other articles:


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Factors influencing early and late outcome following Fontan procedure in the current era
Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 553 - 553.
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