Determination of exact patients’ volume status and appropriate strategy for fluid management during pediatric cardiac surgery are critical factors to obtain stable hemodynamic status and better clinical outcome. It is even more important than in adult cardiac surgery because the large amounts of fluid shifts compared to the patient’s small body surface area can occur. In addition, the inflammatory reactions by the operation of cardiopulmonary bypass (CPB) can aggravate the patient’s unstable hemodynamic state.
Traditional method to evaluate volume status in adult patients is measurement of central venous pressure (CVP) or pulmonary capillary wedge pressure (PCWP). In pediatric patients, CVP also has been widely used to estimate intravascular volume status. However, its use as a marker of exact volume status is inappropriate because of the various factors to affect the accuracy such as venous capacitance, cardiac chamber compliance, cardiac valve competence and pulmonary artery pressure. In addition, the patient’s small size or aberrant anatomy make difficulty to insert a pulmonary artery catheter for PCWP measurement in pediatric patients who have congenital heart disease, and this procedure has a high risk of complications such as rupture of pulmonary artery. 
In the pediatric patients undergoing Fontan procedure, it is more difficult to evaluate the patient’s exact volume status by using CVP measurement because the value of CVP indicates the pulmonary arterial pressure in post-operative period. Therefore, if there is good indicator of patients’ volume status, it will be useful for fluid management in the patients undergoing Fontan procedure. 
The values of thoracic fluid content (TFC) and percentage change in TFC compared with baseline (TFCd0%) derived by the bioreactance technique using non-invasive cardiac output monitoring (NICOM) device already showed good correlation with the amount of fluid removal in patients undergoing hemodialysis and with intraoperative fluid balance in patients undergoing pediatric cardiac surgery. Therefore, we hypothesized that TFC or TFCd0% might be also a useful indicator for fluid management in pediatric patients undergoing Fontan procedure.  
 The aim of this study was to evaluate the utility of TFC or TFCd0% in intraoperative fluid management and its clinical application. Thus, the values of TFC, changes in TFC, intraoperative fluid balance, and changes in body weight were analyzed to evaluate the correlations among them.

Cohort/Group Label

medical records including anesthetic and operative records of patients who had elective Fontan procedure due to congenital functional single ventricle

Cohort/Group Description

medical records including anesthetic and operative records of patients who had elective Fontan procedure due to congenital functional single ventricle from april 2011 to december 2015 - hemodynamic variables measured by non-invasive and invasive monitoring, various variables such as cardiac output, stroke volume, stroke volume variation, thoracic fluid content measured by non-invasive cardiac output monitoring, patients' body weight and intraoperative fluid balance which were recorded at two time points (after anesthetic induction and just before transfer to SICU)

Not collect nor Archive

patients who had elective Fontan procedure due to congenital functional single ventricle in Konkuk University Medical Center from April 2011 to December 2015

By using non-probablity sampling method, patients who had elective Fontan procedure due to congenital functional single ventricle in Konkuk University Medical Center from April 2011 to December 2015 were reviewed retrospectively

Gender

Age

Description

patients who had elective Fontan procedure due to congenital functional single ventricle in Konkuk University Medical Center from April 2011 to December 2015 

incomplete medical record

Thoracic fluid content

at the time of first measurement of NICOM data after anesthesia induction and just before departure from the operating room to the ICU 

Body weight of patient

at the time of first measurement of NICOM data after anesthesia induction and just before departure from the operating room to the ICU 

intraoperative fluid balance (Input/Output) 

just before departure from the operating room to the ICU 

TFCd0%

at the time of first measurement of NICOM data after anesthesia induction and just before departure from the operating room to the ICU 

Mean arterial blood pressure

at the time of first measurement of NICOM data after anesthesia induction and just before departure from the operating room to the ICU 

Heart rate

at the time of first measurement of NICOM data after anesthesia induction and just before departure from the operating room to the ICU 

central venous pressure

at the time of first measurement of NICOM data after anesthesia induction and just before departure from the operating room to the ICU 

Cardiac output and cardiac index

at the time of first measurement of NICOM data after anesthesia induction and just before departure from the operating room to the ICU 

Stroke volume variation

at the time of first measurement of NICOM data after anesthesia induction and just before departure from the operating room to the ICU