A prospective study of risk factors associated with persistent pleural effusion after total cavopulmonary connection with special reference to serum cortisol level

  • Sachin TalwarEmail author
  • Anupam Das
  • Rajesh Khadgawat
  • Manoj Kumar Sahu
  • Shiv Kumar Choudhary
  • Balram Airan
Original Article



The Fontan operation is usually followed by significant pleural effusion. We aimed to study the factors associated with persistent pleural effusion with special reference to serum cortisol levels.

Patients and methods

Thirty-eight patients undergoing the Fontan operation between September 2015 and November 2016 were prospectively studied. Parameters studied included age, weight, symptoms, atrio- ventricular valve regurgitation/stenosis/atresia, ventricular function, pulmonary artery pressures, oxygen saturation, aorto-pulmonary, and veno-venous collaterals, type of Fontan, duration of cardiopulmonary bypass, need for inotropes, duration of mechanical ventilation, conduit size, presence or absence of fenestration, and serum cortisol levels. The latter were measured before and after the Fontan operation and the co-relation between pleural effusion and change in serum cortisol levels was studied.


Mean age at operation was 13.1 ± 5.6 years (median 13 years). Mean duration and amount of pleural drainage was 15.76 ± 13.2 days (median 11.5 days) and 9.15 ± 4.6 mL/kg/day (median 9 mL/kg/day) respectively. Statistically significant risk factors for prolonged pleural effusion were higher pulmonary artery (PA) pressures (r = 0.328, p = 0.003, odds ratio 1.30), higher inotropic score (r = 0.4, p = 0.01), lower rise in serum cortisol (p = 0.03),elevated superior caval venous pressure (CVP) at 6 h (r = 0.44, p = 0.005) and 12 h (r = 0.4, p = 0.01) and higher duration of mechanical ventilation (r = 0.45, p = 0.005).


PA pressures > 15 mmHg, higher inotropic score, higher CVP and lower rise in serum cortisol levels following the Fontan operation were associated with persistent pleural effusion.


Fontan operation Pleural effusion Cortisol 



The authors thank Dr Vishnubhatla Sreenivas, Professor of Biostatistics, All India Institute of Medical Sciences, New Delhi, for statistical analysis.

Compliance with ethical standards

Conflict of interest

All Authors declare that they have no conflict of interest and do not receive any research grants from any company, have not received a speaker honorarium from any company, do not own any stock in any company, and are not members of a committee.

Statement of human rights/ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this study, formal consent was obtained.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2017

Authors and Affiliations

  1. 1.Cardiothoracic CenterAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia

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