Noninvasive estimation of central venous pressure after Fontan procedure using biochemical markers and abdominal echography.

Tatsujiro Oka, Ryuichi Kato, Shigehisa Fumino, Kentaro Toiyama, Masaaki Yamagishi, Toshiyuki Itoi, Kenji Hamaoka

Department of Pediatric Cardiology and Nephrology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

The Journal of thoracic and cardiovascular surgery 2013 Jul

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Patients may develop liver dysfunction, including liver fibrosis, over the long term following Fontan procedure. Therefore, early detection of liver dysfunction is essential to identify those patients who are at risk. We evaluated various laboratory parameters, including liver biochemical markers, hepatic echography findings, and cardiac catheterization outcomes, at an early stage after undergoing Fontan procedure. A total of 56 patients who underwent Fontan procedure were included in the study. All patients underwent cardiac catheterization and biochemical markers were evaluated from the samples. Abdominal echography was performed on a subgroup of patients (n = 20) to observe the structure of liver tissues and to measure blood flow in the hepatic vein, portal vein, and hepatic artery. The mean period of time since Fontan procedure was 2.8 ± 2.1 years. There was a significant correlation between venous pressure and serum levels of γ-glutamyltranspeptidase and type IV collagen 7s domain, which indicated a high probability of liver consolidation. The other biochemical markers were normal. Stepwise regression analyses suggested that by using the ratio of hepatic venous flow and type IV collagen 7s collagen domain concentration, inferior vena cava pressure can be predicted. Our study showed that we can predict inferior vena cava pressure using noninvasive abdominal echography and biochemical markers at an early stage after Fontan procedure. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Citation

Tatsujiro Oka, Ryuichi Kato, Shigehisa Fumino, Kentaro Toiyama, Masaaki Yamagishi, Toshiyuki Itoi, Kenji Hamaoka. Noninvasive estimation of central venous pressure after Fontan procedure using biochemical markers and abdominal echography. The Journal of thoracic and cardiovascular surgery. 2013 Jul;146(1):153-7