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Glenn shunt: effect on pleural drainage after modified Fontan operation.
T M Zellers1, D J Driscoll, R A Humes
1Section of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905.
The Journal of Thoracic and Cardiovascular Surgery
|November 1, 1989
Summary
Patients with a prior Glenn anastomosis undergoing a Fontan operation experienced significantly less pleural drainage. This finding suggests a potential benefit of the Glenn anastomosis in managing post-Fontan fluid accumulation.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Thoracic Surgery
Background:
- The Fontan operation is a palliative procedure for complex congenital heart disease.
- Pleural drainage after the Fontan operation can be substantial, impacting recovery.
- The Glenn anastomosis is sometimes performed prior to the Fontan operation.
Purpose of the Study:
- To investigate whether a prior Glenn anastomosis reduces pleural drainage after the Fontan operation.
- To compare pleural drainage volumes between Fontan patients with and without a prior Glenn anastomosis.
Main Methods:
- Retrospective study of 92 patients who underwent the Fontan operation between 1973 and 1986.
- Patients were divided into two groups: 46 with a prior Glenn anastomosis and 46 matched controls without.
- Pleural drainage volume, pressures, and clinical outcomes were analyzed.
Main Results:
- Patients with a prior Glenn anastomosis had significantly less pleural drainage (median 1,959 ml vs. 3,220 ml, p < 0.05).
- This reduction was also observed in a subgroup matched for prior right thoracotomy (p = 0.028).
- No significant differences were found in hemodynamic pressures, effusion duration, hospital stay, or mortality.
Conclusions:
- A prior Glenn anastomosis is associated with reduced pleural drainage following the Fontan operation.
- This suggests altered fluid dynamics or pressures that mitigate post-operative effusion.
- The Glenn anastomosis may be a beneficial precursor to the Fontan procedure in select patients.