{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:00:48Z","timestamp":1790866848990,"version":"4.1.0"},"reference-count":42,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["World J Pediatr Congenit Heart Surg"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Fontan operation is the final stage of palliation for single-ventricle patients. While operative survival has improved, pleural effusions remain a common postoperative complication, increasing morbidity and hospitalization. Our aim was to investigate the incidence and risk factors for unplanned readmissions due to post-Fontan pleural effusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review of all single ventricle patients who underwent the Fontan procedure from 2012\u20132023 was performed. This case-control study compared post-Fontan patients readmitted to the hospital due to pleural effusion with those who were not. Readmission was defined as rehospitalization for recurrent pleural effusion requiring intravenous diuretics and\/or chest tube placement. Demographics, baseline clinical features, pre-Fontan hemodynamics, type of Fontan surgery, presence of fenestration, cardiac medications and doses, perioperative and post-discharge factors were analyzed between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty-one patients who were 42\u2009\u00b1\u200912.4 months of age underwent the Fontan operation. Of these, 31\/61 (51%) had a diagnosis of hypoplastic left heart syndrome, 32\/61 (52%) underwent extracardiac Fontan surgery, and 33\/61 (54%) had a Fontan fenestration. Nine of 66 (14.7%) patients were readmitted for pleural effusion at a median of 7 days (IQR 5-15) post-discharge. Readmitted patients were older at Fontan (50.4\u2009\u00b1\u200913 vs 40.5\u2009\u00b1\u200911.8 months,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.025), had increased chylothorax incidence (33.3% [3\/9] vs 5.8% [3\/52],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.04), absent or restrictive fenestration at discharge (88.9% [8\/9] vs 44.2% [23\/52],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.03) and were more likely to have pleural effusion at the first postoperative clinic visit (100% [9\/9] vs 13.5% [7\/52],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.01). When comparing maximal diuretic usage, the readmitted patients required more diuretics (median 3 vs 2,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.01). There were no significant differences in race, gender, weight at Fontan, cardiac anatomy, pre-Fontan hemodynamics, Fontan type, initial fenestration status, cardiopulmonary bypass duration time, supplemental oxygen duration, chest tube duration, number and doses of cardiac medications prior to and at Fontan discharge, or length of hospital stay. No patient required catheter-based intervention or surgery within 3 months post-Fontan discharge.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Older age at Fontan, chylothorax, absent\/restrictive fenestration at discharge, and detection of pleural effusion at the first postoperative clinic visit are risk factors for readmission due to pleural effusion. Earlier Fontan timing, optimizing diuretic management, and ensuring Fontan fenestration patency may reduce readmissions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501351261418295","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T10:49:58Z","timestamp":1775558998000},"page":"776-784","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Unplanned Readmissions due to Pleural Effusion Following the Fontan Operation"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6615-7329","authenticated-orcid":false,"given":"Jean M.","family":"Meneses","sequence":"first","affiliation":[{"name":"Penn State College of Medicine, Penn State Health Children's Hospital"},{"name":"Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2483-2425","authenticated-orcid":false,"given":"Mohan","family":"Pankhuri","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine, Penn State Health Children's Hospital"},{"name":"Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5281-4704","authenticated-orcid":false,"given":"Jake","family":"Beerel","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine, Penn State Health Children's Hospital"},{"name":"Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4531-0168","authenticated-orcid":false,"given":"Joseph B.","family":"Clark","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine, Penn State Health Children's Hospital"},{"name":"Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4775-1851","authenticated-orcid":false,"given":"John L.","family":"Myers","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine, Penn State Health Children's Hospital"},{"name":"Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA"},{"name":"Department of Surgery, Penn State College of Medicine, Hershey, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8485-2953","authenticated-orcid":false,"given":"Allen R.","family":"Kunselman","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine, Penn State Health Children's Hospital"},{"name":"Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3334-2886","authenticated-orcid":false,"given":"Akif","family":"\u00dcndar","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine, Penn State Health Children's Hospital"},{"name":"Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA"},{"name":"Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA"},{"name":"Department of Biomedical Engineering, College of Engineering, The Pennsylvania State University, University Park, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent P. R.","family":"Aluquin","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine, Penn State Health Children's Hospital"},{"name":"Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.01.056"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.007764"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2015.06.042"},{"key":"e_1_3_4_5_2","first-page":"65","article-title":"\u201cWill she live a long happy life?\u201d Parents\u2019 concerns for their children with Fontan circulation","volume":"18","author":"du Plessis K","year":"2018","unstructured":"du Plessis K, Peters R, King I, et al. \u201cWill she live a long happy life?\u201d Parents\u2019 concerns for their children with Fontan circulation. Int J Cardiol. 2018;18:65-70.","journal-title":"Int J Cardiol"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2003.09.011"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/hc0202.102237"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951120004618"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.4103\/apc.apc_76_23"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/jscai.2023.101174"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-020-02365-4"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-020-02457-1"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-019-02183-3"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/000313480907500213"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-015-1217-2"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/hc37t1.094817"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12055-017-0617-8"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.001396"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezu489"},{"issue":"11","key":"e_1_3_4_20_2","first-page":"1","article-title":"Impact of fenestration on outcomes of the Fontan procedure: A systematic review and meta-analysis","volume":"8","author":"Akbar PA","year":"2024","unstructured":"Akbar PA, Hakim AR. Impact of fenestration on outcomes of the Fontan procedure: A systematic review and meta-analysis. Journal of Angiotherapy. 2024;8(11):1-8.","journal-title":"Journal of Angiotherapy"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.11.046"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-024-03744-x"},{"key":"e_1_3_4_23_2","first-page":"1957","article-title":"Postoperative outcomes of Fontan operation in a multicenter Italian study. How far have we gone? Early outcomes after Fontan operation","volume":"46","author":"Cao IRE","year":"2024","unstructured":"Cao IRE, Bergonzoni E, Vedovelli L, et al. Postoperative outcomes of Fontan operation in a multicenter Italian study. How far have we gone? Early outcomes after Fontan operation. Pediatr Cardiol. 2024;46(7):1957-1967.","journal-title":"Pediatr Cardiol"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951123000264"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2022.06.037"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.09.068"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-024-03494-w"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000696"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(99)01067-X"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)33930-3"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2009.02.059"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2019180877"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-015-3514-6"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.06.077"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2023.05.021"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0b013e3283396efc"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951120003121"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2014.06.121"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2019.12.020"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.100846"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.11.041"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-024-03455-3"},{"issue":"7","key":"e_1_3_4_43_2","first-page":"1189","article-title":"Creation of a transcatheter fenestration in children with failure of Fontan circulation: Focus on extracardiac conduit connection","volume":"86","author":"Rupp S","year":"2015","unstructured":"Rupp S, Schieke C, Kerst G, et al. Creation of a transcatheter fenestration in children with failure of Fontan circulation: Focus on extracardiac conduit connection. Catheter Cardiovasc Interv. 2015;86(7):1189-1194.","journal-title":"Catheter Cardiovasc Interv"}],"container-title":["World Journal for Pediatric and Congenital Heart Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501351261418295","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21501351261418295","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501351261418295","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:47:38Z","timestamp":1790866058000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21501351261418295"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,7]]},"references-count":42,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1177\/21501351261418295"],"URL":"https:\/\/doi.org\/10.1177\/21501351261418295","relation":{},"ISSN":["2150-1351","2150-136X"],"issn-type":[{"value":"2150-1351","type":"print"},{"value":"2150-136X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,7]]}}}