title: Fontan Circulation in Adult Patients: Acoustic Radiation Force Impulse Elastography as a Useful Tool for Liver Assessment.
abstract: The development of liver fibrosis and cirrhosis due to long-standing liver congestion is known to occur in adult patients with Fontan circulation. Hepatic elastography has shown to be a useful tool for the noninvasive assessment and staging of liver fibrosis in chronic liver diseases, although the utility of this technique in Fontan patients remains to be adequately studied.
  
  
  
  Twenty-one patients with Fontan circulation underwent an abdominal ultrasound and an acoustic radiation force impulse (ARFI) elastography. In order to compare the results from this group, a cohort of 14 healthy controls and another group containing 17 patients with cirrhosis were included. The association between the velocity values measured with elastography and clinical and analytical parameters were also studied.
  
  
  
  Mean shear waves propagation velocity in liver tissue in the Fontan group was 1.86 ± 0.5 m/s, with 76% of patients over the cirrhosis threshold (1.55 m/s). The control group had a mean velocity of 1.09 ± 0.06 m/s, while the cirrhotic group obtained 2.71 ± 0.51 m/s. Seven patients with Fontan circulation had increased liver enzymes. Liver ultrasound showed evidence of chronic liver disease in six patients. Velocity values obtained in the presence or absence of analytical or liver ultrasound abnormalities showed significant differences in the univariate analysis (P = .04 and P = .03 respectively).
  
  
  
  In conclusion, ARFI elastography showed increased wave propagation velocity values in the Fontan population suggesting increased liver stiffness which could be related to advanced fibrosis. A statistically significant association between ARFI values and the presence of analytical and ultrasound abnormalities has been demonstrated.
authors: Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Área Clínica del Corazón, Hospital Universitari i Politècnic La Fe, Valencia, España josep.melero@gmail.com.
authors: Josep Lluís
authors: JL
authors: Melero-Ferrer
authors: Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Área Clínica del Corazón, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors: Ana
authors: A
authors: Osa-Sáez
authors: Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain.
authors: Francisco
authors: F
authors: Buendía-Fuentes
authors: Área Clínica de Imagen Médica, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors: Antonio
authors: A
authors: Ballesta-Cuñat
authors: Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
authors: Lucía
authors: L
authors: Flors
authors: Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Área Clínica del Corazón, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors: María
authors: M
authors: Rodríguez-Serrano
authors: Área Clínica de Imagen Médica, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors: Pilar
authors: P
authors: Calvillo-Batllés
authors: Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors: Miguel-Ángel
authors: MÁ
authors: Arnau-Vives
authors: Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors: Miguel A
authors: MA
authors: Palencia-Pérez
authors: Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Área Clínica del Corazón, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors: Joaquín
authors: J
authors: Rueda-Soriano
mesh_terms: D000293:Adolescent; D000328:Adult; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D055815:Young Adult
keywords: ARFI; Fontan circulation; congenital heart disease; congestive liver disease; elastography; liver cirrhosis; liver fibrosis