ABC | Volume 115, Nº1, Suplement, July 2020

Clinicoradiological Correlation Atik et al. Prolonged pleural effusion after Fontan operation in complex heart defect Arq Bras Cardiol 2020; 115(1Suppl.1):31-33 (6 to 8 g / kg / day), furosemide (4 mg / kg / day), sildenafil (3 mg / kg / day) day), spironolactone (2 mg / kg / day) and water restriction. The bilateral pleural effusion was exaggerated and corresponded to a volume of 300 to 500 mL per day, in a persistent manner. Due to infection in pleural fluids, the patient received antibiotics that did not solve the persistent problem. On the 34 th postoperative day, cardiac catheterization was performed. The mean pulmonary pressure was 16 mmHg. In the arterial angiography, 4 discrete points of systemic-pulmonary vessels’ connection were detected, sparsely distributed in the 2 lungs, coming from the internal thoracic arteries and the descending aorta. They did not cause increased saturation in the pulmonary arteries, but they were still closed by coils and an Amplatzer arterial plug (Figure 2). Four days after the interventionist catheterization, the interruption of pleural drainages was observed, followed by the consequent removal of chest drains on the 39 th postoperative day. The patient was discharged on the 41 st postoperative day. Figure 1 – Chest x-rays in the postoperative period of cavopulmonary surgery in complex heart disease. The two images on the left depict the pleural effusions and the one on the left shows after the placement of arterial coils and plug in the demonstration of the normal and hypertrophic cardiac area. Comments: The postoperative evolution of the cavopulmonary operation has many surprises, even in patients with all the adequate parameters of ventricular function, size of the pulmonary arteries, pulmonary pressure and resistance, among the main ones. The formation of systemic-pulmonary fistulas seems to occur almost immediately due to the difference in pressures that are established between arterial systems. Even if they do not seem so exuberant, their embolization is necessary, especially when the pleural effusion is persistent and there is no other evident cause. In this case, the long post-operative time that allowed for the expected accommodation of the pulmonary flow in the context of its arterial and venous tree counts as another favorable factor. The literature shows no cases with a longer duration of pleural effusion. Other procedures in similar cases include fenestration, pleurodesis, thoracic duct ligation and Fontan takedown 1,2 . 32