PT  - JOURNAL ARTICLE
AU  - Baek, Jae Suk
AU  - Bae, Eun Jung
AU  - Ko, Jae Sung
AU  - Kim, Gi Beom
AU  - Kwon, Bo Sang
AU  - Lee, Sang Yun
AU  - Noh, Chung Il
AU  - Park, Eun-Ah
AU  - Lee, Whal
TI  - Late hepatic complications after Fontan operation; non-invasive markers of hepatic fibrosis and risk factors
AID  - 10.1136/hrt.2010.201772
DP  - 2010 Nov 01
TA  - Heart
PG  - 1750--1755
VI  - 96
IP  - 21
4099  - http://heart.bmj.com/content/96/21/1750.short
4100  - http://heart.bmj.com/content/96/21/1750.full
SO  - Heart2010 Nov 01; 96
AB  - 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.