Kim Seong-Ook, Lee Sang-Yun, Jang So-Ick, Park Soo-Jin, Kwon Hye-Won, Kim Seong-Ho, Lee Chang-Ha, Choi Eun-Seok, Cho Seong-Kyu, Hong Sun-Hwa, Kim Yang-Min
Department of Pediatrics, Sejong General Hospital, 91-121, Sosabon2-dong, Sosa-gu, Bucheon-Si, Gyeonggi-do, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon-Si, Republic of Korea.
Pediatr Cardiol. 2018 Jan;39(1):57-65. doi: 10.1007/s00246-017-1727-1. Epub 2017 Sep 21.
Hepatic problems related to a Fontan circulation have been highlighted and elastography using ultrasound is a non-invasive tool that can measure the severity of hepatic stiffness. We investigated the hepatic stiffness using shear wave elastography (SWE) and related factors in patients with a Fontan circulation. This study enrolled 64 patients with a Fontan circulation who underwent cardiac catheterization and abdominal ultrasound from 2011 to 2015. The correlation between the laboratory tests, hemodynamic factors by cardiac catheterization, and SWE was evaluated. The patients were classified into non-cirrhotic level (≥ 2.0 m/s) and cirrhotic level (< 2.0 m/s) groups by the SWE value. The mean age was 17.6 years and the mean duration after the Fontan operation was 12.1 years. The mean value of SWE in patients (1.95 m/s) was higher than the normal (< 1.3 m/s). The SWE was higher in patients without than those with a fenestration (2.03 vs. 1.75 m/s, P = 0.003). In a multiple regression analysis between SWE and other factors, the CVP, fenestration, and lipoprotein Apo B had a significant correlation. In a multivariate analysis of cirrhotic level group, the CVP was the only significant factor. The hepatic stiffness had significantly progressed in most patients with a Fontan circulation. A low CVP and Fontan circulation with a fenestration might reduce the progression of the hepatic stiffness.
与Fontan循环相关的肝脏问题已受到关注，而超声弹性成像作为一种非侵入性工具，能够测量肝脏硬度的严重程度。我们采用剪切波弹性成像（SWE）对Fontan循环患者的肝脏硬度及其相关因素进行了研究。本研究纳入了2011年至2015年间接受心脏导管检查和腹部超声检查的64例Fontan循环患者。评估了实验室检查、心脏导管检查的血流动力学因素与SWE之间的相关性。根据SWE值将患者分为非肝硬化水平（≥2.0 m/s）组和肝硬化水平（<2.0 m/s）组。患者的平均年龄为17.6岁，Fontan手术后的平均病程为12.1年。患者的SWE平均值（1.95 m/s）高于正常水平（<1.3 m/s）。无开窗的患者SWE高于有开窗的患者（2.03 vs. 1.75 m/s，P = 0.003）。在SWE与其他因素的多元回归分析中，中心静脉压（CVP）、开窗情况和脂蛋白Apo B具有显著相关性。在肝硬化水平组的多因素分析中，CVP是唯一的显著因素。大多数Fontan循环患者的肝脏硬度有显著进展。低CVP和有开窗的Fontan循环可能会减缓肝脏硬度的进展。
