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Ann Thorac Surg 1994;57:937-939
© 1994 The Society of Thoracic Surgeons

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Articles

Therapeutic implications of intraoperative pressure measurements after the fontan operation

Division of Thoracic and Cardiovascular Surgery, Information Services, and the Department of Diagnostic Radiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Accepted for publication August 2, 1993.

^_* Address reprint requests to Dr Schaff, Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

Central venous pressure (CVP) and left atrial pressure (LAP) were monitored continuously for the first 72 hours postoperatively in 32 patients who underwent a Fontan operation in whom preoperative measurements of the pulmonary artery index were available. Integrated mean values were generated for each patient for the following time frames: (1) the first 12 hours after operation, (2) the first 24 hours after operation, (3) postoperative day 2, and (4) postoperative day 3. We found no difference in the CVP, LAP, or transpulmonary gradient, derived as CVP — LAP, measured in the operating room at the completion of the operation versus that measured on the third postoperative day: CVP, 18 ± 2 mm Hg versus 19 ± 3 mm Hg; LAP, 10 ± 2 mm Hg versus 10 ± 3 mm Hg; and transpulmonary gradient, 8 ± 2 mm Hg versus 8 ± 2 mm Hg. The combined incidence of hospital mortality and postoperative takedown associated with the Fontan repair was 12.5%. These findings suggest that a poor hemodynamic result from the Fontan operation can be predicted from intraoperative pressure measurements, because the CVP, LAP, and transpulmonary gradient are unlikely to change significantly in the early postoperative period. Therefore, a decision to take down or fenestrate the repair can reasonably be nude in the operating room or the early postoperative period.

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