title: Non-invasive assessment of liver fibrosis by magnetic resonance elastography in patients with congenital heart disease undergoing the Fontan procedure and intracardiac repair.
abstract: The incidence of late liver complications such as fibrosis or cirrhosis has increased among patients who have undergone the Fontan procedure. Magnetic resonance elastography (MRE) recently emerged as a technique to clinically evaluate liver fibrosis. However, few reports have described its use in evaluating liver fibrosis in children with congenital heart disease (CHD).
  
  
  
  Fifty-seven children were examined and divided into four groups: 27 with CHD who underwent intracardiac repair (ICR); 16 with CHD who underwent the Fontan procedure (Fontan); 14 in a control group (control); and two with cirrhosis (cirrhosis). Liver stiffness (LS) was measured using MRE. Other assessments included central venous pressure (CVP) as determined by cardiac catheterization. Circulating biomarker levels were also determined. There were no significant differences in biomarker levels among the groups. However, the LS degree was significantly higher in the Fontan group than in the control group. On stepwise multivariate analysis, only the CVP level was a statistically significant independent predictor of LS. There was also a strong correlation between LS and CVP and between LS and time interval since Fontan surgery.
  
  
  
  This study clearly demonstrated that LS was significantly increased after the Fontan procedure and that CVP was a predictor of LS. MRE is a highly sensitive tool that can evaluate liver fibrosis in children who undergo the Fontan procedure and enable earlier detection of LS than biomarkers.
authors.affiliation: Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan. Electronic address: masaya5p@asahikawa-med.ac.jp.
authors.forename: Masaya
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Oka
authors.affiliation: Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Kajihama
authors.affiliation: Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Nakau
authors.affiliation: Department of Pediatric Cardiology, Saitama Medical Centre, Saitama Medical University, Kawagoe, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Kuwata
authors.affiliation: Department of Pediatric Cardiology, Saitama Medical Centre, Saitama Medical University, Kawagoe, Japan.
authors.forename: Clara
authors.initials: C
authors.lastname: Kurishima
authors.affiliation: Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Azuma
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002496:Central Venous Pressure; D002648:Child; D054459:Elasticity Imaging Techniques; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008297:Male; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Congenital heart disease; Elasticity; Fontan procedure; Liver; Magnetic resonance