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Updated: Jul 31, 2026
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Parameters associated with perioperative baffle fenestration closure in the Fontan operation
A Casta1, E M Gruber, P C Laussen
1Department of Anesthesia, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Insights
Early closure of the fenestration after a Fontan operation in children may be indicated by a high transpulmonary pressure gradient, high oxygen saturation, low fibrinogen, and need for atrial pacing.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
Background:
- The fenestrated Fontan operation is a palliative procedure for single-ventricle physiology.
- Fenestration closure is a critical event in the perioperative period.
Purpose of the Study:
- To identify clinical indicators of early fenestration closure following the fenestrated Fontan operation in pediatric patients.
Main Methods:
- Retrospective study of 101 children who underwent a fenestrated Fontan operation.
- Analysis of perioperative clinical parameters, including cardiac catheterization, ultrasound data, and postoperative intensive care unit (ICU) variables.
Main Results:
- Early fenestration closure occurred in 14 patients.
- Multivariate analysis identified a high transpulmonary pressure gradient, higher oxygen saturation post-ICU arrival, low fibrinogen levels, and the need for temporary atrial pacing as significant indicators of closure.
- No early mortality was observed, with all patients surviving to discharge.
Conclusions:
- Clinical parameters such as transpulmonary pressure gradient, oxygen saturation, fibrinogen levels, and atrial pacing requirements can predict early fenestration closure after a fenestrated Fontan operation.
Objective:
To identify clinical parameters indicating perioperative fenestration closure in children who underwent the fenestrated Fontan operation.
Design:
Retrospective.
Setting:
Single children's hospital.
Participants:
Patients who underwent a fenestrated Fontan operation in 1996 through 1997 (n = 101).
Intervention:
A fenestrated Fontan operation was performed in children with single-ventricle physiology.
Measurements And Main Results:
Early perioperative closure of the fenestration occurred in 14 patients (group 1), whereas the fenestration remained patent in 87 patients (group 2). The groups were compared by the following parameters: demographics, cardiac catheterization and ultrasound data, and use of aspirin or warfarin preoperatively and intraoperatively by assessing the composition of the cardiopulmonary bypass solution, use of ultrafiltration and antifibrinolytics, protamine dose, last hematocrit on cardiopulmonary bypass, and requirement of blood products. Immediately postoperatively in the intensive care unit (ICU), cardiac filling pressures (central venous and left atrial pressure), coagulation profile, cardiac rhythm, chest tube drainage, length of stay in the ICU, and use of atrial pacing were reviewed. Significant indicators of early fenestration closure in this study as determined by multivariate stepwise logistic regression were a high transpulmonary pressure gradient (p = 0.015) and a higher oxygen saturation (p = 0.001) 1 hour after arrival in the ICU, a low fibrinogen level (p < 0.0001), and the need for temporary atrial pacing (p = 0.029). The fenestration was reopened in 13 patients in group 1. In 101 patients, there was no early mortality, and all patients survived to discharge.
Conclusion:
Factors that correlated with postoperative fenestration closure in the fenestrated Fontan operation in this study were a high transpulmonary pressure gradient and a high oxygen saturation 1 hour after arrival in the ICU, a low fibrinogen level, and the need for temporary atrial pacing.
