Author + information
- Shaija Shelbya,b,
- David Danforda,b,
- Jonathan Cramera,b,
- Angela Yetmana,b,
- Shane Tsaia,b,
- Ling Lia,b,
- Scott Fletchera,b,
- Ruben Quiros-Tejeiraa,b and
- Shelby Kuttya,b
Background: Hepatic dysfunction is a recognized complication in single ventricle heart disease, however it is unknown if patients with repaired biventricular heart disease (BHD) are prone to hepatic changes manifested as elevated stiffness. We measured hepatic stiffness and vascular Doppler indices using ultrasound (US) and shear wave elastography (SWE) in a BHD cohort.
Methods: BHD patients and normal controls were recruited for hepatic US with SWE. US-SWE system (SuperSonic Imagine) and transducers enabled generation of transient shear waves with real-time B-mode imaging. Using Q-box plug-in with OsiriX, stiffness measurements were expressed as Young's Modulus (kPa). Doppler measurements were made in celiac and superior mesenteric arteries, and main portal vein. These were peak velocities, velocity time integral, resistive, pulsatility and acceleration indices (RI, PI, AI), and portal vein flow volume. Comparisons were made between BVD, controls and a historical cohort of Glenn and Fontan patients.
Results: Fifty-eight subjects were prospectively studied: 28 BHD (8 female, age 27.2±4.3 years, weight 78.3±22 kg) and 30 controls (23 female, age 27.4±3.8 years, weight 70.0±17 kg). Diagnoses were tetralogy of Fallot/pulmonary atresia (n=14), transposition of great arteries (n=13), and anomalous pulmonary venous return (n=1). BHD had lower superior mesenteric artery PI (2.47 vs. 2.94, p=0.05) and higher main portal vein PI (0.70 vs. 0.50, p=0.008) compared to controls. No association was seen in stiffness or other indices with age, gender, or time since surgical repair. Hepatic stiffness (kPA) was 8.0 ± 2.1 in BHD, 6.8 ± 2.3 in Glenn (n=20, age 2±1 years) and 15.6 ± 5.1 in Fontans (n=41, age 14±6 years); differences between BHD and Fontan were significant (p<0.001), whereas between BHD and Glenn was not (p=0.11).
Conclusions: Decreased hepatic elasticity occurs in some young adults with repaired BHD. Although the cause is not established, considerations include pre-or peri-operative hepatic congestion early in life, and/or chronic right heart burden later after repair. Further research is required to determine if these patients will ultimately suffer from clinically relevant liver disease.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Adult Patients With Congenital Heart Disease: How Do They Compare?
Abstract Category: 9. Congenital Heart Disease: Adult
Presentation Number: 1142-015
- 2017 American College of Cardiology Foundation