RT Journal Article
SR Electronic
T1 Late hepatic complications after Fontan operation; non-invasive markers of hepatic fibrosis and risk factors
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1750
OP 1755
DO 10.1136/hrt.2010.201772
VO 96
IS 21
A1 Jae Suk Baek
A1 Eun Jung Bae
A1 Jae Sung Ko
A1 Gi Beom Kim
A1 Bo Sang Kwon
A1 Sang Yun Lee
A1 Chung Il Noh
A1 Eun-Ah Park
A1 Whal Lee
YR 2010
UL http://heart.bmj.com/content/96/21/1750.abstract
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.