title: The precarious state of the liver after a Fontan operation: summary of a multidisciplinary symposium.
abstract: As the cohort of survivors with the single-ventricle type of congenital heart disease grows, it becomes increasingly evident that the state of chronically elevated venous pressure and decreased cardiac output inherent in the Fontan circulation provides the substrate for a progressive decline in functional status. One organ at great risk is the liver. Wedged between two capillary beds, with the pulmonary venous bed downstream, which typically has no pulsatile energy added in the absence of a functional right ventricle, and the splanchnic bed upstream, which may have compromised inflow due to inherent cardiac output restriction characteristic of the Fontan circulation, the liver exists in a precarious state. This review summarizes a consensus view achieved at a multidisciplinary symposium held at The Children's Hospital of Philadelphia in June 2011. The discussion includes current knowledge concerning the hemodynamic foundations of liver problems, the diagnostic tools available, the unique histopathology of the liver after the Fontan operation, and proposed mechanisms for hepatic fibrosis at the cellular level. At the completion of the symposium, a consensus recommendation was made by the authors' group to pursue a new prospective protocol for clinical evaluation of the liver for all patients in our practice 10 years after the Fontan operation.
authors.affiliation: Division of Cardiology, Single Ventricle Survivorship Program, The Cardiac Center at Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. rychik@email.chop.edu
authors.forename: Jack
authors.initials: J
authors.lastname: Rychik
authors.forename: Gruschen
authors.initials: G
authors.lastname: Veldtman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rand
authors.forename: Pierre
authors.initials: P
authors.lastname: Russo
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
authors.forename: Karen
authors.initials: K
authors.lastname: Krok
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Cahill
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Wells
mesh_terms: D002302:Cardiac Output; D002648:Child; D002675:Child, Preschool; D003226:Congresses as Topic; D018729:Fontan Procedure / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000098:blood supply*; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology*; D008111:Liver Function Tests