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

Byung Won Yoo, Jae Young Choi, Lucy Youngmin Eun, Han Kim Park, Young Hwan Park, Seung Up Kim

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

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 (R30 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.

Original languageEnglish
Pages (from-to)1498-1505
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number4
DOIs
Publication statusPublished - 2014 Oct 1

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Fontan Procedure
Elasticity Imaging Techniques
Liver
Aspartate Aminotransferases
Bilirubin
Blood Platelets
Heart Failure
Inferior Vena Cava
Leukocyte Count
Serum Albumin
Liver Cirrhosis
Ultrasonography
Spleen
Multivariate Analysis
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Yoo, Byung Won ; Choi, Jae Young ; Eun, Lucy Youngmin ; Park, Han Kim ; Park, Young Hwan ; Kim, Seung Up. / Congestive hepatopathy after Fontan operation and related factors assessed by transient elastography. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 148, No. 4. pp. 1498-1505.
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abstract = "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 (R30 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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Congestive hepatopathy after Fontan operation and related factors assessed by transient elastography. / Yoo, Byung Won; Choi, Jae Young; Eun, Lucy Youngmin; Park, Han Kim; Park, Young Hwan; Kim, Seung Up.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 4, 01.10.2014, p. 1498-1505.

Research output: Contribution to journalArticle

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T1 - Congestive hepatopathy after Fontan operation and related factors assessed by transient elastography

AU - Yoo, Byung Won

AU - Choi, Jae Young

AU - Eun, Lucy Youngmin

AU - Park, Han Kim

AU - Park, Young Hwan

AU - Kim, Seung Up

PY - 2014/10/1

Y1 - 2014/10/1

N2 - 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 (R30 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.

AB - 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 (R30 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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