title: Cardiac abnormalities in cirrhotic children: pre- and post-liver transplantation.
abstract: OBJECTIVE
  Liver cirrhosis is associated with several cardiac abnormalities. There have been few studies of these abnormalities in cirrhotic children post-liver transplantation (LT). The purpose of this study was to evaluate cardiac abnormalities in cirrhotic children pre- and post-LT.
  
  
  METHODS
  All cirrhotic children <15 years of age on a waiting list for LT underwent pre-LT echocardiography to evaluate left ventricular (LV) dimension, mass, and function. Repeated studies were performed at 1-2 and 3-6 months post-LT.
  
  
  RESULTS
  A total of 20 cirrhotic children (median age 21.5 months [8-108 months], 11 female [55 %]) were enrolled in the study. Most patients had biliary atresia (75 %) and decompensated cirrhosis, with a median pediatric end-stage liver disease score of 19.5 (14-28). Two patients subsequently died, at 1 and 4 months post-LT. Echocardiography was re-evaluated in 17 and 18 patients at 1-2 months and 3-6 months post-LT, respectively. Prior to transplant, most patients had cardiac abnormalities, including LV enlargement (50 %), increased LV mass (95 %), abnormal LV geometry (95 %), hyperdynamic LV systolic function (60 %), LV diastolic dysfunction (60 %), and high cardiac index (75 %). At 3-6 months post-LT, no significant decrease in cardiac abnormalities was noted; however, cardiac parameters including LV dimension in diastole index and z-score, LV mass index, and relative wall thickness were significantly decreased.
  
  
  CONCLUSIONS
  Most cirrhotic children had cardiac abnormalities, including LV enlargement, increased LV mass, abnormal LV geometry, and LV dysfunction. These abnormalities tended to improve post-LT. We suggest that echocardiography should be performed in all cirrhotic children.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Khemika
authors.initials: K
authors.lastname: Khemakanok
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand. anant.kho@mahidol.ac.th.
authors.forename: Anant
authors.initials: A
authors.lastname: Khositseth
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Suporn
authors.initials: S
authors.lastname: Treepongkaruna
authors.affiliation: Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Sumate
authors.initials: S
authors.lastname: Teeraratkul
authors.affiliation: Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Wichai
authors.initials: W
authors.lastname: Pansrimangkorn
authors.affiliation: Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Surasak
authors.initials: S
authors.lastname: Leelaudomlipi
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Uthen
authors.initials: U
authors.lastname: Bunmee
authors.affiliation: Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Suthus
authors.initials: S
authors.lastname: Sriphojanart
mesh_terms: D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology
keywords: Cirrhosis; Echocardiography; Liver transplantation; Pediatrics