Abstract:

Objective To summarize the clinical outcome and hemodynamic feature after Fontan operation, and explore the main points of intensive care after operation. Methods Seventy-nine patients undergoing Fontan operation between July 2008 and July 2009 were collected. The main points of intensive care after operation and clinical outcome were summarized through analysis of the hemodynamic feature and course of intensive care. Results Five patients died early after operation, and the mortality was 6.33%. There was no death in stage 1 operation, the mortality of stage 2 operation was 9.3%, and the mortality of stage 3 operation was 14.3%. The echocardiogram demonstrated the generalized reduction in blood flow in inferior vena cava after operation, and right to left shunt in fenestration was observed on the first day after operation in all cases. Early withdrawl of mechanical ventilation led to an optimal recovery in hemodynamics. There was a higher incidence of organ dysfunction after operation. Conclusion Hemodynamic assessment before operation is important for the clinical outcome of Fontan operation. The slow flow in inferior vena cava and the dominant right to left shunt in fenestration after operation may affect the perfusion of organs, and the early withdrawl of mechanical ventilation is recommended. The close relationship between heart and lung after Fontan operation demands the management of pulmonary complications without delay. The main points to improve the low cardiac output are volume resuscitation, suitable inotropic support and pulmonary resistance reduction. The unique effect of milrinone in the treatment after Fontan operation is emphasized.

Key words: Fontan operation, fenestration, clinical outcome, postoperative care