RENIN, ANGIOTENSIN-II, AND THE DEVELOPMENT OF EFFUSIONS FOLLOWING BIDIRECTIONAL GLENN AND FONTAN PROCEDURES

Pleural effusions are a troublesome complication following bidirection al Glenn and Fontan procedures. It was our hypothesis that effusions m ay be related to alterations in hormones that regulate fluid homeostas is. We made serial determinations (by radioimmunoassay) of antidiureti c hormone, cortisol, aldosterone, angiotensin II, and renin in patient s undergoing bidirectional Glenn (n = 16) and Fontan procedures (n = 2 4). There were six patients who developed effusions following surgery. These patients had a different endocrinological pattern characterized by persistent elevation in renin (28 +/- 9 vs 9 +/- 5 ng/mL per hour, p < 0.01) and angiotensin II (110 +/- 33 vs 33 +/- 14 ng/L, p < 0.01) on the fifth postoperative day as compared to patients who did not de velop effusions. These data demonstrate that patients who develop effu sions following bidirectional Glenn and Fontan procedures have activat ion of their renin-angiotensin system.