The prevalence and risk factors for cholelithiasis and asymptomatic gallstones in adults with congenital heart disease.
OBJECTIVE
Cyanosis is considered to be a risk factor for cholelithiasis which is an important complication of cyanotic congenital heart disease (CCHD) in adults. In this study, the prevalence of cholelithiasis and asymptomatic calcium bilirubinate gallstones was evaluated in adults with congenital heart disease (CHD). Furthermore, risk factors for this potentially high risk complication were assessed.


METHODS
Subjects were derived from 114 consecutive congenital patients who visited our center from May 2008 to January 2009. For analyses of risk factors, we divided them into 4 groups: group A, 15 CCHD patients without reparative surgery (7 men, 31.8 ± 7.0 years old); group B, 41 CCHD patients rendered acyanotic by reparative surgery (21 men, 32.5 ± 11.8 years old); group C, 23 unoperated acyanotic CHD patients (11 men, 42.4 ± 16.4 years old); and group D, 35 patients who were acyanotic before and after operation (18 men, 36.3 ± 14.8 years old). Gallstones were identified by abdominal ultrasound and risk factors were analyzed by a multivariate logistic regression model.


RESULTS
Cholecystectomy was performed in 5/114 (4.3%), asymptomatic gallstones were seen in 16/114 (14%), and symptomatic gallstones except for patients after cholecystectomy were seen in 7/114 (6.1%). In group A, 4 (27%) with gallstones underwent cholecystectomy (p<0.01). Non-cholesterol gallstones were observed in 5 patients (33%) in group A, 12 patients (29%) in group B, nobody in group C, and 3 patients (8.6%) in group D. By a multivariate logistic regression model, CCHD by nature regardless of repair, prolonged cyanosis periods, higher frequency of cardiopulmonary bypass (CPB), and lower platelet counts were significant factors predicting gallstones (odds ratio 4.48, 1.08, 3.96, and 0.87, 95% CI, 1.14-17.5, 1.00-1.18, 1.65-9.54, and 0.75-0.99, respectively).


CONCLUSIONS
The prevalence of cholelithiasis and asymptomatic gallstones is significantly high in CCHD patients regardless of cardiac repairs. CCHD by nature, prolonged cyanosis durations, high frequency of CPB and low platelet counts have influences on gallstone formation in adults with CHD.
Shiina
Yumi
Y
Department of Adult Congenital Heart Disease and Pediatrics, Chiba Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba 290-0512, Japan.
Toyoda
Tomohiko
T
Kawasoe
Yasutaka
Y
Tateno
Shigeru
S
Shirai
Takeaki
T
Matsuo
Kozo
K
Mizuno
Yoshiko
Y
Ai
Toshiji
T
Niwa
Koichiro
K
D000328:Adult; D058070:Asymptomatic Diseases; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000706:statistics & numerical data; D002769:Cholelithiasis / Q000150:complications* / Q000601:surgery; D003490:Cyanosis / Q000209:etiology; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000601:surgery; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010976:Platelet Count; D015995:Prevalence; D012307:Risk Factors