Transjugular liver biopsy for Fontan associated liver disease surveillance: Technique, outcomes and hemodynamic correlation

Borquez, Alejandro A.; Silva-Sepulveda, Jose; Lee, Jesse W.; Vavinskaya, Vera; Vodkin, Irine; El‐Sabrout, Hannah; Towbin, Richard B.; Perry, James C.; Moore, John W.; El‐Said, Howaida

doi:10.1016/j.ijcard.2020.11.037

Cited by 17 publications

(14 citation statements)

References 29 publications

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“…Laboratory work included complete blood and platelet counts, serum proteins, and liver function tests; however, we did not routinely obtain alpha-2-macroglobulin, haptoglobin, apolipoprotein A1, or gamma-glutamyl transpeptidase. Although some advocate percutaneous liver biopsy, 20 similar to others, 19,[21][22][23] we performed a transvenous hepatic biopsy. Transvenous liver biopsy is safe, effective, and appears not to overestimate the degree of hepatic fibrosis, a potential concern that some have raised for the transvenous technique.…”

Section: Cardiac Catheterization and Liver Biopsymentioning

confidence: 92%

Hepatic fibrosis gender differences in extracardiac Fontan patients

Evans

Acherman

Restrepo

2022

Journal of Cardiac Surgery

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Objective We investigated possible gender differences for hepatic fibrosis in extracardiac‐Fontan patients. Methods We identified extracardiac Fontan, performed between 2000 and 2016, who underwent cardiac catheterizations with transvenous hepatic biopsies between April 2012 and June 2022. We divided the patients by gender for analysis. Results We identified 116 patients who underwent 145 transvenous biopsies, with 29 patients undergoing 2 biopsies at an average interval of 5 ± 1 years. We divided the 145 biopsies into two groups: 1) 98/145 (68%) males and 2) 47/145 (32%) females. For the 47 female liver biopsy specimens, the median total fibrosis score was 3 (0–8), and for the 98 male liver biopsy specimens, the median total fibrosis score was 2 (0–6), p = .007. The average age at surgery for females was 3 ± 1 years and for males 3 ± 1 years, p = .99. Average Fontan duration at biopsy for females was 11 ± 5 years and for males, 10 ± 4 years, p = .23. No other demographic, anatomic, echocardiographic, laboratory, or hemodynamic findings demonstrated statistically significant gender differences. Conclusions Females had statistically significantly higher median total fibrosis scores than males for the similar average age at extracardiac Fontan and average Fontan duration.

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Section: Cardiac Catheterization and Liver Biopsymentioning

confidence: 92%

Hepatic fibrosis gender differences in extracardiac Fontan patients

Evans

Acherman

Restrepo

2022

Journal of Cardiac Surgery

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“…Liver biopsy remains important in the evaluation of liver lesions in patients with Fontan physiology, as discussed previously. Despite concern for increased risk associated with biopsy in patients with Fontan physiology, studies suggest that biopsy can be safely completed through either a percutaneous [ 116 ] or transjugular [ 124 ] route with similar complication rates to the non‐Fontan population. However, biopsies obtained through a transjugular route may be more likely to overestimate the severity of FALD due to the tendency to sample the area adjacent to the central vein.…”

Section: Diagnosis Of Faldmentioning

confidence: 99%

Fontan‐associated liver disease

et al. 2022

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“…25 The transjugular route is safer and can be easily performed during a routine cardiac catheterization. 26 Sinusoidal dilatation is the earliest parenchymal change and periportal inflammation is usually minimal or absent, allowing its differential diagnosis with other etiologies. In the early stages of FALD, fibrosis follows a predominantly perisinusoidal pattern, but in the long term, the histological pattern of advanced FALD is distinguished by the combination of portal and sinusoidal fibrosis.…”

Section: Liver Biopsymentioning

confidence: 99%

Fontan-Associated Liver Disease: Pathophysiology, Staging, and Management

2021

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Fontan-associated liver disease is the term used to encompass the disorders arising from abnormal hemodynamic alterations and systemic venous congestion after the Fontan procedure. The histological changes produced in the liver are similar but not equivalent to those seen in other forms of cardiac liver disease. While the natural history of this form of liver disease is poorly established, many Fontan patients ultimately develop portal hypertension-related complications such as ascites, esophageal varices, malnutrition, and encephalopathy. Fontan survivors also show an elevated risk of hepatocellular carcinoma. Adequate staging of the liver damage is essential to anticipate screening strategies and improve global management.

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Transjugular liver biopsy for Fontan associated liver disease surveillance: Technique, outcomes and hemodynamic correlation

Cited by 17 publications

References 29 publications

Hepatic fibrosis gender differences in extracardiac Fontan patients

Hepatic fibrosis gender differences in extracardiac Fontan patients

Fontan‐associated liver disease

Fontan-Associated Liver Disease: Pathophysiology, Staging, and Management

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