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Original Articles: Pediatric Cardiac

Liver and Cardiac Function in the Long Term After Fontan Operation

^a Department of Pediatric Hepatology, University of Padova, Padova, Italy
^b Department of Pediatric Cardiology, University of Padova, Padova, Italy
^c Department of Pediatric Cardiac Surgery, University of Padova, Padova, Italy

Accepted for publication March 31, 2008.

^_* Address correspondence to Dr D'Antiga, Paediatric Department, University of Padova, Via Giustiniani 3, Padova, 35128, Italy (Email: lorenzo.dantiga{at}pediatria.unipd.it).

Background: Patients who underwent Fontan operation have some degree of liver disease. We aimed to assess the long-term liver and cardiac function after Fontan operation.

Methods: Patients enrolled underwent physical examination, biochemical tests (aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase, bilirubin, international normalized ratio, coagulation factor V, protein profile, fecal alpha-1-antitrypsin), echocardiogram, and liver ultrasonography. A liver disease score was adopted to compare the degree of liver involvement with hemodynamic features.

Results: The study enrolled 34 patients, median age 14.7 years (range, 4.1 to 26.7), 26 with a residual left ventricle, 8 with a residual right ventricle, affected by tricuspid atresia (17), pulmonary atresia (4), hypoplastic left heart syndrome (5), double-outlet right ventricle (2), single left ventricle (2), and miscellaneous (4), with median follow-up of 11.5 years (range, 1.7 to 23.3). We found hepatomegaly in 18 of 34 (53%), splenomegaly in 3 of 33 (9%), abnormal transaminases in 10 of 33 (30%), elevated GT in 19 of 31 (61%), elevated bilirubin in 10 of 31 (32%), coagulopathy in 17 of 29 (58%), and protein-losing enteropathy in 4 of 21 (19%). Median heart rate z-score was –1.72. Hepatic dysfunction was strictly correlated to low cardiac index (r² = 0.34, p = 0.008) and to a lesser extent to reduced heart rate (r² = 0.18, p = 0.07).

Conclusions: In children who underwent Fontan operation, hepatic dysfunction is correlated with low cardiac index and reduced heart rate. Maintaining or reestablishing a normal cardiac index might prevent or reduce liver disease in the long-term.