Late hepatic complications after Fontan operation; non-invasive markers of hepatic fibrosis and risk factors. Issue 21 (18th October 2010)

• Record Type: Journal Article
• Authors: Baek, Jae Suk; Bae, Eun Jung; Ko, Jae Sung; Kim, Gi Beom; Kwon, Bo Sang; Lee, Sang Yun; Noh, Chung Il; Park, Eun-Ah; Lee, Whal
• Is Part Of: Heart. Volume 96:Issue 21(2010)
• Page Start: 1750
• Page End: 1755
• Publication Date: 2010-10-18
• Subjects: Liver cirrhosis -- Fontan operation -- congenital heart defect -- paediatric cardiology; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2010.201772
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: To identify the prevalence, clinical characteristics, risk factors of hepatic complications after a Fontan operation. Methods: This was a cross-sectional study of 139 Fontan patients who underwent cardiac CT scans out of a total of 204 patients who had undergone the Fontan procedure between 1986 and 2003. Mean age was 19.0±6.3 years and mean elapsed time since the initial Fontan operation was 11.5±4.7 years. Subjects' clinical features, echocardiograms, radiological features and biochemical test results were reviewed. Various non-invasive hepatic fibrosis blood markers were also evaluated. Results: Fifty-seven patients had hepatic complications, including radiological features of liver cirrhosis (25.9%), thrombocytopenia (7.2%), hyperbilirubinaemia (20.9%) and hepatic masses (2.9%). Hepatic complications were also significantly associated with ventricular dysfunction (p=0.020), absence of fenestration (p=0.004), thrombus in the Fontan tract (p=0.027), sinus node dysfunction (p=0.034) and tachyarrhythmia (p<0.001). In a multivariate analysis, the elapsed time since the initial Fontan operation was the only measure that was correlated with hepatic complications; the odds ratio of the post-Fontan duration of 16–20 years to that of 0–5 years was 9.00 (CI 2.24 to 36.17). The non-invasive hepatic fibrosis blood marker (Forns index) was also correlated with the elapsed time since the initial Fontan operation (r=0.718, p<0.001). Conclusion: Late hepatic dysfunction and cirrhotic change were often seen in Fontan patients. Moreover, hepatic complications were correlated with the duration of Fontan circulation. Therefore, after a Fontan operation, regular evaluation of the hepatic condition is required—for which some non-invasive hepatic fibrosis markers can be effectively used.