Pediatric Cardiology

, Volume 40, Issue 8, pp 1545–1552 | Cite as

Risk Factors for Prolonged Pleural Effusion After Extracardiac Fontan Operation

  • Geena Kim
  • Hoon Ko
  • Joung-Hee Byun
  • Hyoung Doo LeeEmail author
  • Hyungtae Kim
  • Si Chan Sung
  • Kwang Ho Choi
Original Article


Prolonged pleural effusion after Fontan operation is a significant morbidity that leads to long hospital stays. We investigated the association of multiple risk factors, including clinical characteristics, hemodynamic parameters, and preoperative, operative, and postoperative factors, with prolonged pleural effusion after Fontan operation. Eighty-five patients who underwent a Fontan operation between January 2005 and June 2018 in our center were included in this retrospective study. Patients were divided into two groups: group 1 (n = 36, 42.4%) included those with prolonged pleural effusion, defined as lasting > 14 days after the Fontan operation, and group 2 included patients without prolonged pleural effusion. Patients with hypoplastic left heart syndrome (HLHS) were more prevalent in group 1 (n = 15, P = 0.006). No differences in age at Fontan operation, central venous pressure at Fontan operation, or hemodynamic parameters during the pre-Fontan evaluation were found between the two groups. In multivariable analysis, HLHS (P = 0.002), non-fenestration (P = 0.018), and high central venous pressure at bidirectional cavopulmonary shunt (BCPS) operation (P = 0.043) were independent risk factors for prolonged pleural effusion after Fontan operation. Adverse outcomes such as death, need for heart transplantation, and Fontan failure were not associated with prolonged pleural effusion. In conclusion, patients with HLHS and higher central venous pressure at BCPS were more likely to have a prolonged pleural effusion after Fontan operation, but fenestration was more likely to decrease prolonged effusion. We should consider closer management of fluid status before, during, and after surgery in patients with these risk factors after Fontan operation.


Fontan procedure Functional single ventricle Chylothorax Prolonged pleural effusion 



This work was supported by a 2‐year research grant from Pusan National University.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Geena Kim
    • 1
  • Hoon Ko
    • 1
  • Joung-Hee Byun
    • 1
  • Hyoung Doo Lee
    • 1
    • 2
    Email author
  • Hyungtae Kim
    • 1
  • Si Chan Sung
    • 1
  • Kwang Ho Choi
    • 1
  1. 1.Heart CenterPusan National University Children’s HospitalYangsanRepublic of Korea
  2. 2.Department of PediatricsResearch Institute for Convergence of Biomedical Science and Technology, Pusan National University College of MedicineYangsanRepublic of Korea

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