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Congestive hepatopathy after Fontan operation and related factors assessed by transient elastography

 Byung Won Yoo  ;  Jae Young Choi  ;  Lucy Youngmin Eun  ;  Han Ki Park  ;  Young Hwan Park  ;  Seung Up Kim 
 Journal of Thoracic and Cardiovascular Surgery, Vol.148(4) : 1498-1505, 2014 
Journal Title
 Journal of Thoracic and Cardiovascular Surgery 
Issue Date
OBJECTIVE: Congestive hepatopathy after a Fontan operation can have a major effect on long-term morbidity. We evaluated congestive hepatopathy in patients with Fontan circulation using transient elastography to determine which risk factors for hepatopathy are related to liver stiffness (LS). METHODS: We evaluated 46 patients with Fontan circulation and 26 with right side heart failure (RHF) and hepatic congestion using laboratory tests, the aspartate aminotransferase-to-platelet ratio index, ultrasonography, and transient elastography. RESULTS: The LS value was significantly greater in the Fontan group (21.1±8.0 kPa) than in the RHF group (10.0±9.0 kPa). The total bilirubin and albumin serum levels, white blood cell count, and aspartate aminotransferase to platelet ratio index correlated significantly with LS in the Fontan group. Of the risk factors, age at evaluation (r=0.42, P=.004), age at Fontan completion (r=0.51, P<.001), inferior vena cava diameter (r=0.35, P=.02), and spleen size (r=0.53, P=.002) correlated significantly with LS. Nineteen patients in the Fontan group (41.3%) had abnormal ultrasound findings, and the frequency of abnormal findings increased with increasing LS (P=.002). In the subgroup with the greatest LS value (≥30 kPa), 88.9% had abnormal ultrasound findings and 44.4% liver cirrhosis. Multivariate analysis revealed that age at Fontan procedure completion and total bilirubin were independent risk factors for hepatopathy. CONCLUSIONS: The present study revealed that congestive hepatopathy developed in a significant fraction of patients with long-term Fontan circulation and that transient elastography could be an easy and useful method to assess congestive hepatopathy in these patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Yoo, Byung Won(류병원) ORCID logo https://orcid.org/0000-0001-6895-1484
Park, Young Hwan(박영환)
Park, Han Ki(박한기) ORCID logo https://orcid.org/0000-0002-7472-7822
Eun, Lucy Youngmin(은영민) ORCID logo https://orcid.org/0000-0002-4577-3168
Choi, Jae Young(최재영) ORCID logo https://orcid.org/0000-0002-1247-6669
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