Pediatric Fontan associated liver disease: Non-invasive evaluation with serologic markers and acoustic radiation force impulse (ARFI) elastography

Sylvia Y. Ofei, Karen Texter, Cheryl Gariepy, Sally Smith, Ali N. Zaidi, Christina Phelps

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Hepatic fibrosis is a significant complication in adult Fontan patients suggesting development as a function of time since the surgery. Children with Fontan circulation are not routinely assessed for development of liver disease. We aimed to evaluate the effectiveness of serologic biomarkers and acoustic radiation force impulse (ARFI) elastography to detect liver disease in pediatric Fontan patients. Patients ≥1 year after Fontan operation prospectively had hepatic US with acoustic radiation force impulse and laboratory testing. Clinical cardiac data (echocardiograms, cardiac catheterizations) were reviewed. Statistical analysis was performed using Pearson's correlation coefficient, Wilcoxon rank-sum test and Kruskal-Wallis test. Forty patients were enrolled with median age of 11 years and median time since Fontan of 6.5 years. Platelet count negatively correlated with years since Fontan (p < 0.000). Thrombocytopenia was noted in 15% of patients with the lowest platelet count of 78 K/cu mm, in a patient >10 years from the Fontan (DORV) operation. Alanine transaminase (ALT, p = 0.034) and aspartate aminotransferase (AST, p = 0.009) were higher in patients with Extracardiac Conduit Fontan compared to those with Extracardiac Pericardial and Lateral Fontan operations. Heterogeneous echotexture on liver ultrasound correlated with years since Fontan (p = 0.022), however all acoustic radiation force impulse values were elevated (>1.34 m/s) and did not correlate with age, years since Fontan, labs or imaging. FibroSure values did not correlate with years since Fontan. This suggests that ARFI may be elevated due to passive hepatic congestion, limiting its value in this patient population. Additional testing is necessary to identify reliable non-invasive screening modalities for hepatic fibrosis in Fontan patients. Our study is the largest pediatric study to evaluate ARFI in patients after the Fontan operation and showed increased shear wave speed for all patients with no correlation with time since palliation. Decreasing platelet count may indicate the development of liver fibrosis.

Original languageEnglish
Pages (from-to)21-27
Number of pages7
JournalProgress in Pediatric Cardiology
Volume53
DOIs
StatePublished - Jun 2019

Bibliographical note

Funding Information:
The Center for Cardiovascular & Pulmonary Research and The Heart Center at Nationwide Children's Hospital (Grant # 20053514), Columbus, Ohio, USA. National Institutes of Health T32 Training Grant in Congenital and Acquired Heart Disease sponsored by the Research Institute at Nationwide Children's Hospital and the Davis Heart and Lung research Institute at The Ohio State University (Grant: 5 T32 HL 98039-5), Columbus, Ohio, USA.

Funding Information:
Study was performed using research funding from The Center for Cardiovascular & Pulmonary Research and The Heart Center at Nationwide Children's Hospital (Grant # 20053514). Dr. Sylvia Ofei was a trainee under the National Institutes of Health T32 Training Grant in Congenital and Acquired Heart Disease sponsored by the Research Institute at Nationwide Children's Hospital and the Davis Heart and Lung research Institute at The Ohio State University (Grant: 5 T32 HL 98039-5). The Center for Cardiovascular & Pulmonary Research and The Heart Center at Nationwide Children's Hospital (Grant # 20053514), Columbus, Ohio, USA. National Institutes of Health T32 Training Grant in Congenital and Acquired Heart Disease sponsored by the Research Institute at Nationwide Children's Hospital and the Davis Heart and Lung research Institute at The Ohio State University (Grant: 5 T32 HL 98039-5), Columbus, Ohio, USA. None.

Funding Information:
Study was performed using research funding from The Center for Cardiovascular & Pulmonary Research and The Heart Center at Nationwide Children's Hospital (Grant # 20053514 ). Dr. Sylvia Ofei was a trainee under the National Institutes of Health T32 Training Grant in Congenital and Acquired Heart Disease sponsored by the Research Institute at Nationwide Children's Hospital and the Davis Heart and Lung research Institute at The Ohio State University (Grant: 5 T32 HL 98039-5 ).

Funding Information:
The Center for Cardiovascular & Pulmonary Research and The Heart Center at Nationwide Children's Hospital (Grant # 20053514 ), Columbus, Ohio, USA. National Institutes of Health T32 Training Grant in Congenital and Acquired Heart Disease sponsored by the Research Institute at Nationwide Children's Hospital and the Davis Heart and Lung research Institute at The Ohio State University (Grant: 5 T32 HL 98039-5 ), Columbus, Ohio, USA.

Funding Information:
This prospective, single-center, cross-sectional, observational study was approved by the Institutional Review Board at Nationwide Children's Hospital. It was funded by an institutional grant from the Center for Cardiovascular & Pulmonary Research and The Heart Center. Dr. Sylvia Ofei was also supported by the NIH/NHLBI T32 training grant in Congenital and Acquired Heart Disease.

Publisher Copyright:
© 2019

Keywords

  • Acoustic radiation force impulse (ARFI)
  • Congenital heart disease
  • Congestive hepatopathy
  • Elastography
  • Fontan
  • Hepatic fibrosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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