Title : Hepatic pathology in patients after the fontan operation
Hepatic dysfunction is an important long-term complication in Fontan patients. The purpose of this study is to evaluate the hepatic findings after Fontan surgery on computed tomography (CT) and their association with clinical parameters. This study recruited 43 patients (M/F 23/20, age 15.3±6.8 years) who underwent Fontan surgery. Medical record was reviewed for age, sex, congenital heart disease type, date of Fontan surgery, laboratory data, and hepatic CT findings. The relationship between hepatic findings and clinical parameters was analyzed.
Follow-up duration was 6.8±4.1 years. The abnormal hepatic parenchymal enhancement was present in 77% of patients with mild degree (n=18), moderate degree (n=10), and severe degree (n=5). Risk factors associated with hepatic parenchymal enhancement included follow-up duration (p=0.042), hypoplastic left ventricle syndrome (p=0.002), mean pulmonary artery pressure (p=0.026), pulmonary vascular resistance index (p=0.032), and brain natriuretic peptide (p=0.045). Abnormal hepatic parenchymal enhancement detected by CT scan is common in Fontan patients. Regular liver function test in conjunction with the imaging study may be considered during following the Fontan patients.
Audience take away:
• To recognize the severity of hepatic abnormality in Fontan patients by the imaging study of liver.
• To manage hepatic abnormality in Fontan patients by decreasing elevated pulmonary artery pressure and pulmonary vascular resistance.
• To follow up Fontan patients regularly including hepatic imaging study for decreasing the serious complications such as liver cirrhosis or carcinoma by early adequate treatment.