title: Three cases of hepatocellular carcinoma in Fontan patients: Review of the literature and suggestions for hepatic screening.
abstract: The Fontan procedure has been used since 1971 as a palliative treatment for various (functionally) univentricular hearts. The systemic venous blood flows passively to the pulmonary arteries, without passing through a functional ventricle. This results in chronic systemic venous congestion, which may lead to liver fibrosis, cirrhosis and hepatocellular carcinoma. This review discusses possible screening modalities for liver fibrosis and cirrhosis in the Fontan population and proposes a screening protocol. We suggest starting screening for progression of fibrosis and cirrhosis in collaboration with the hepatologist circa 10 years after Fontan completion. The screening programme will consist of a yearly evaluation of liver laboratory tests in conjunction with imaging of the liver with ultrasound or MRI every two years. In case of liver fibrosis or cirrhosis, (reversible) causes should be ruled out (e.g. obstruction in the Fontan circuit). In case of severe fibrosis or cirrhosis, other complications of portal hypertension should be evaluated and screening for hepatocellular carcinoma is required on a regular (6-12 months) basis. As regards hepatocellular carcinoma, treatment should be discussed in a multidisciplinary team, before deciding a treatment modality.
authors.affiliation: Department of Cardiology, Medisch Spectrum Twente Hospital, Enschede, The Netherlands. Electronic address: Dj.jitta@mst.nl.
authors.forename: Djike
authors.initials: D
authors.lastname: Josephus Jitta
authors.affiliation: Department of Cardiology, Medisch Spectrum Twente Hospital, Enschede, The Netherlands.
authors.forename: Lodewijk J
authors.initials: LJ
authors.lastname: Wagenaar
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.affiliation: Department of Gastroenterology, Medisch Spectrum Twente Hospital, Enschede, The Netherlands.
authors.forename: Maureen
authors.initials: M
authors.lastname: Guichelaar
authors.affiliation: Department of Radiology, Medisch Spectrum Twente Hospital, Enschede, The Netherlands.
authors.forename: Donald
authors.initials: D
authors.lastname: Bouman
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: J.p.van.Melle@UMCG.nl.
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods; D018729:Fontan Procedure / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D008297:Male; D013997:Time Factors