THERAPEUTIC IMPLICATIONS OF INTRAOPERATIVE PRESSURE MEASUREMENTS AFTER THE FONTAN OPERATION

Central venous pressure (CVP) and left atrial pressure (LAP) were moni tored continuously for the first 72 hours postoperatively in 32 patien ts who underwent a Fontan operation in whom preoperative measurements of the pulmonary artery index were available. Integrated mean values w ere 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 di fference in the CVP, LAP, or transpulmonary gradient, derived as CVP - LAP, measured in the operating room at the completion of the operatio n versus that measured on the third postoperative day: CVP, 18 +/- 2 m m 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 as sociated 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 t ranspulmonary gradient are unlikely to change significantly in the ear ly postoperative period. Therefore, a decision to take down or fenestr ate the repair can reasonably be made in the operating room or the ear ly postoperative period.