@article {Baek1750, author = {Jae Suk Baek and Eun Jung Bae and Jae Sung Ko and Gi Beom Kim and Bo Sang Kwon and Sang Yun Lee and Chung Il Noh and Eun-Ah Park and Whal Lee}, title = {Late hepatic complications after Fontan operation; non-invasive markers of hepatic fibrosis and risk factors}, volume = {96}, number = {21}, pages = {1750--1755}, year = {2010}, doi = {10.1136/hrt.2010.201772}, publisher = {BMJ Publishing Group Ltd}, 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{\textpm}6.3 years and mean elapsed time since the initial Fontan operation was 11.5{\textpm}4.7 years. Subjects{\textquoteright} 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{\textendash}20 years to that of 0{\textendash}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{\textemdash}for which some non-invasive hepatic fibrosis markers can be effectively used.}, issn = {1355-6037}, URL = {https://heart.bmj.com/content/96/21/1750}, eprint = {https://heart.bmj.com/content/96/21/1750.full.pdf}, journal = {Heart} }