Noninvasive Assessment of Liver Stiffness in Patients Undergoing the Fontan Procedure

Background: Hepatic derangements and liver injury following the Fontan operation (FO) may progress in some cases to hepatic fibrosis (HF) and cirrhosis. The respective roles of transient elastography (TE) or FibroScan, shear wave elastography (SWE), and aspartate transaminase to platelet ratio index...

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Published in:World journal for pediatric & congenital heart surgery 2020-09, Vol.11 (5), p.572-577
Main Authors: Talwar, Sachin, Gudala, Vasubabu, Joshi, Raja, Shalimar, DM, Madhusudhan, Kumble Seetharama, Kalaivani, Mani, Choudhary, Shiv Kumar
Format: Article
Language:English
Subjects:
Adolescent
Child
Elasticity
Elasticity Imaging Techniques - methods
Female
Fontan Procedure - methods
Heart Defects, Congenital - complications
Heart Defects, Congenital - surgery
Humans
Liver - diagnostic imaging
Liver - physiopathology
Liver Cirrhosis - complications
Liver Cirrhosis - diagnosis
Liver Cirrhosis - physiopathology
Male
Preoperative Care - methods
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Summary:Background: Hepatic derangements and liver injury following the Fontan operation (FO) may progress in some cases to hepatic fibrosis (HF) and cirrhosis. The respective roles of transient elastography (TE) or FibroScan, shear wave elastography (SWE), and aspartate transaminase to platelet ratio index (APRI) in assessing liver stiffness (LS) and possible liver injury in these patients are unclear. Methods: Thirty-nine patients (31 males), mean age 11.8 ± 5.7 years, median 11 years (interquartile range: 7-14.7 years), undergoing the FO between November 2017 and December 2018 were included. Liver stiffness and HF assessment was done with TE, SWE, and APRI in the preoperative period and postoperatively at 3-, 6-, and 12-month interval. Results: The LS values increased over time (postoperative values at 3, 6, and 12 months) as compared to preoperative values by both FibroScan and SWE. The change in liver stiffness measurement (LSM) was statistically significant: LSM0 to LSM3 (P ≤ .0001), LSM0 to LSM6 (P ≤ .0001), and LSM0 to LSM12 (P = .001). Similarly, significant changes were observed on SWE: SWE0 to SWE3 (P ≤ .0001), SWE0 to SWE6 (P ≤ .0001), and SWE0 to SWE12 (P = .001). There was no significant change in the APRI values over time. Conclusion: Noninvasive methods such as FibroScan and SWE may be of use to assess LS in follow-up of patients undergoing the FO for early recognition of hepatic changes.
ISSN:2150-1351
2150-136X
DOI:10.1177/2150135120935418