Author + information
- Shaija Shelby,
- Qinghai Peng,
- Rallyn Renner,
- Ling Li,
- Cynthia Scott,
- Marion Meckelburg,
- Scott E. Fletcher,
- John Kugler,
- Kim F. Duncan,
- Ruben E. Quiros-Tejeira,
- David A. Danford and
- Shelby Kutty
Liver dysfunction is a recognized complication with the Fontan physiology. We sought to evaluate quantitative ultrasonic measurement of liver stiffness in a Fontan cohort using shear wave elastography (SWE).
Patients and age-matched controls were prospectively recruited for same day 2D echocardiography and duplex liver ultrasound with SWE. The SWE ultrasound system (SuperSonic Imagine Aixplorer®) and selected transducers (SC6-1, SL15-4) enabled generation of transient shear waves simultaneously with real-time B-mode imaging. Using a Q-box™ plug-in with OsiriX software, stiffness measurements were expressed in terms of Young's Modulus (kPa). Duplex measurements were made in the celiac and superior mesenteric arteries, and the main portal vein (MPV). These were peak velocities, velocity time integral (VTI), resistive, pulsatility and acceleration indices (RI, PI, AI), MPV flow volume, and MPV and right liver lobe diameters. Comparisons were made with controls and correlations explored between SWE, Duplex and clinical data.
Twenty-seven patients (18 male, 9 female, age 14 ±6 yrs, time since Fontan 11±6 yrs, weight 44±24 kg) and 29 controls (14 male, 15 female, age 14.5±7 yrs, weight 53±20 kg) were studied. It was feasible to obtain measurements in all subjects. Patients had significantly higher SWE values (15.5 vs. 5.2 kPa, p<0.0001) and superior mesenteric artery RI (8.8 vs. 8.3, p=0.04), while the MPV flow volume (260 vs. 470 ml/ min in controls, p=0.003) and AI (32 cm/s2 vs. 49 in controls, p=0.01) were lower. AI tended to decrease with time since Fontan (P=0.07), but no significant change was seen in SWE or other Duplex indices with age, gender, time since Fontan, VO2 max or ventricular morphology. MPV flow volume and celiac artery RI and PI correlated inversely with SWE.
Fontan physiology is associated with remarkably abnormal liver stiffness, and changes in hepatic vascular flow patterns. SWE measurements are feasible in young patients and the findings are of great concern, but their value in patient management is not established in this cross sectional study. Longitudinal SWE determinations and correlation with liver biopsy findings are planned.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Single Ventricles
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1203-120
- 2013 American College of Cardiology Foundation