Abstract
Pleural effusions after the Fontan procedure contribute to morbidity, prolonged hospital stay, increased risk of infection, and may necessitate a pleurodesis procedure. Although the exact pathophysiological pathways are not fully understood, diuretics are generally used for the treatment of pleural effusions. On the other hand, postoperative elevation in antidiuretic hormone and decrease in atrial natriuretic peptide have been proven, indicating an effect of resistance to diuretic therapy. This paper reports on the efficacy of a high-dose diuretics regimen to prevent pleural effusions in the early postoperative period after the Fontan procedure.
From June 1997 to November 2012, 36 cases underwent the Fontan procedure. From August 2008, a new regimen using high-dose diuretics has been adopted and applied to 15 patients. Four out of 15 patients were excluded from this study due to early death or serious complications, so 11 patients were defined as the high-dose group. Before August 2008, 3 out of 21 patients were excluded for a similar reason, with 18 patients being defined as the control group. The high-dose group received a high-dose diuretic regimen that consisted of 20 mg of furosemide and 20 mg of spironolactone, three times a day after every meal. Perioperative data and postoperative course were compared between the two groups retrospectively.
Patient characteristics were not significantly different between the two groups. However, preoperative body weight was lower in the high-dose group(10.3±1.12 vs. 11.8±2.34kg, p<0.05). The average amount of urine from postoperative day 1 to day 3 was significantly higher in the high-dose group(49.2±10.7 vs. 40.0±14.6ml /kg/day, p<0.05). The amount of chest drainage was significantly lower in the high-dose group(486±182 vs. 870±635ml , p<0.05). No patients received drip infusions of albumin preparation in the high-dose group, while 6 out of 18 patients received it in the control group. Further pleural drainage after the removal of chest tubes was performed on eight patients in the control group, but it was performed only twice on one patient in the high-dose group(p<0.05). No patient showed serious complications, such as renal failure, thrombus formation, arrhythmias, reintubation, the need for increasing inotropic support, or the need for pleural sclerosis.
The high-dose diuretics regimen using furosemide and spironolactone after the Fontan procedure increased urine in the early postoperative period, reduced overall pleural effusions, and minimized the need for additional treatment.
