Background Fenestration of the baffle/conduit is believed to reduce pleural effusion following the Fontan operation. However, equivocal results have been observed with or without fenestration. This study aims to evaluate the efficacy of fenestration on the amount and duration of pleural effusion following the Fontan operation. Methods About 40 patients undergoing extracardiac Fontan (ECF) were randomized into two groups: one with fenestration (ECF‐F; n = 20) or without fenestration (ECF‐NF; n = 20). Primary outcome was the amount and duration of pleural effusions. Secondary outcomes were time to removal of the chest tubes, hospital stay, and readmission to the hospital because of recurrent pleural within 30 days of the operation. Results Mean age was 11.5 ± 5.07 (range, 8.7‐13.5) years in the ECF‐F group and 13.6 ± 0.4 years (range, 10.5‐15.5) in the (ECF‐NF) group. The total drain output was 7.89 mL/kg/d in ECF‐NF compared with 6.9 mL/kg/d in the ECF‐group (P = .14). Time for removal of pleural tubes was 14.6 ± 0.95 days in the ECF‐NF group compared with 11.6 ± days in the ECF‐F group. Total duration of hospital stay was higher but not significant in the ECF‐NF group compared with the ECF‐F group. Two patients in ECF‐NF required readmission to the hospital within 30 days following discharge, while there were no readmissions in the ECF‐F group. Conclusion Contrary to the literature, the creation of a fenestration in the ECF circuit was not clearly associated with a reduction in the amount and duration of pleural effusion compared with a non‐fenestrated Fontan. These findings may be debatable in high risks versus low risk candidates. However in the present study, in a low risk canditates undergoing the Fontan operation, the daily amount of pleural drainage was no different. Larger studies are needed to confirm these findings.
We present 13 years old with history of cyanosis and diagnosis of congenitally corrected transposition of great arteries with ventricle septal defect and pulmonary stenosis with dextrocardia. He underwent modified Senning procedure with pulmonary root translocation. Postoperative recovery was uneventful and was extubated on postoperative day 1. Patient remained in sinus rhythm. Postoperative echocardiography showed good biventricular function with no baffle obstruction and mild pulmonary regurgitation with no significant left and right outflow tract obstruction. Patient was discharged on postoperative day 6 and remained asymptomatic on follow up at 3 months.
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