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Ann Thorac Surg 1994;57:59-64
© 1994 The Society of Thoracic Surgeons

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Articles

Comparison of the hormonal response after bidirectional glenn and fontan procedures

^a Divisions of Cardiac Surgery, Cardiology, and Pathology, Children's Hospital and Health Center, San Diego, USA
^b The Nichols Institute, San Juan Capistrano, California, USA

^_* Address reprint requests to Dr Mainwaring, 8008 Frost St, Suite 400. San Diego, CA 92123.

Fluid retention is a frequent complication after the bidirectional Glenn and Fontan procedures. It was our hypothesis that this fluid retention may have a hormonal basis. To test this hypothesis, we made serial determinations of antidiuretic hormone, cortisol, aldosterone, angiotensin, and renin before and after operation in patients undergoing a bidirectional Glenn (n = 15) or Fontan (n = 18) procedure. Patients undergoing a bidirectional Glenn procedure had elevations in antidiuretic hormone, cortisol, and aldosterone immediately after operation. However, none of the hormonal elevations persisted by the fifth postoperative day. In contrast, patients undergoing a Fontan procedure had elevations in antidiuretic hormone, cortisol, aldosterone, renin, and angiotensin II in the immediate postoperative period. Five days postoperatively, the renin and angiotensin II levels remained elevated compared with the preoperative values. The data demonstrate that patients undergoing a bidirectional Glenn procedure and those undergoing a Fontan procedure have different patterns of hormonal response. These results suggest that hormonal factors may contribute to fluid retention after these operations.

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