Objective Early Fontan Failure (EFF) is a serious complication following total cavopulmonary connection (TCPC), characterised by high central venous pressure (CVP), low cardiac output and resistance to medical therapy. This study aimed to estimate post-operative CVP in TCPC patients (CVPTCPC) using data routinely collected during pre-operative assessment. We sought to determine if this metric correlated with measured post-operative CVP and if it was associated with EFF. Methods In this retrospective study, CVPTCPC was estimated in 131 patients undergoing pre-TCPC assessment by cardiac magnetic resonance imaging and CVP measurement under general anaesthesia. Post-operative CVP during the first 24hours in ICU was collected from electronic patient records in a subset of patients. EFF was defined as death, transplantation, TCPC takedown or emergency fenestration within the first 30days. Results Estimated CVPTCPC correlated significantly with CVPICU (r=0.26, p=0.03), particularly in patients without a fenestration (r=0.45, p=0.01). CVPTCPC was significantly associated with EFF (Odds Ratio [OR] 1.12 (1.02-1.24), p=0.02). A threshold of CVPTCPC ≥33mmHg was found to have the highest specificity (90%) and sensitivity (67%) for identifying EFF (area under receiver operating curve, AUC = 0.79), OR 18.8 (3.1-114), p=0.001. This association was stronger in patients with single SVCs. Conclusions Estimated CVPTCPC is an easily calculated metric combining pre-operative pressure and flow data. Higher CVPTCPC is associated with an increased risk of EFF and is correlated with directly measured post-TCPC pressure. Identification of patients at risk of EFF has the potential to guide risk mitigation strategies.

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Background: Penile fracture is a urological emergency that occurs following a traumatic rupture of the tunica albuginea. Patients experience an audible ‘pop’ and immediate detumescence during sexual activity, followed by pain, swelling and ecchymosis. It is uncommon for patients to present without these typical clinical findings. Case Presentation: This case report describes a 33-year-old male with an atypical penile fracture and associated urethral injury. He reported mild pain as his penis buckled against his partner’s thigh during sexual intercourse and a sudden detumescence. Examination was unremarkable other than gross blood at the external urethral meatus. MRI identified a 4 mm focal capsular defect at the ventral aspect of the left corpora cav-ernosum. Flexible cystoscopy identified a 2cm longitudinal tear in the distal urethra. The patient underwentsuccessful surgical repair with no long term sequalae.Conclusions: The authors of this report wish to highlight the importance of keeping a high index of suspi-cion for penile fractures in light of a typical history.