Martínez-Quintana Efrén, Rodríguez-González Fayna
Cardiology Service, Complejo Hospitalario Universitario Insular-Materno Infantil Las Palmas de Gran Canaria, Spain.
Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria Las Palmas de Gran Canaria, Spain.
Am J Cardiovasc Dis. 2021 Oct 25;11(5):611-617. eCollection 2021.
Hepatic complications are common in patients with Fontan surgery. The objective of this observational study is to compare demographic, clinical and blood test data in patients older than 14 years old with a Fontan procedure (cases) and asymptomatic patients with single non-operated restrictive ventricular septal defect (VSD) (controls) and to determine whether there are differences in blood collection and liver disease scores according to the liver ultrasound findings in the group of Fontan patients. The liver findings were classified as mild (normal or heterogeneous echogenicity) and significant (nodular surface, small hyperechoic nodules or hepatocarcinoma). 74 patients (14 patients with a Fontan procedure and 60 patients with a restrictive VSD) were included in the study. Median age was 18 (14-45) years old and 41 patients were males. Fontan patients had significantly lower platelet count, lower mean platelet volume (MPV) and lower glucose levels than patients with single non-operated restrictive VSD. On the contrary, Fontan patients showed higher liver enzymes [aspartate aminotransferase (AST) and alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT)], N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and thyroid-stimulating hormone (TSH) concentrations than patients with restrictive VSD. 4 out of 14 (29%) patients with Fontan operation and significant liver ultrasound findings showed greater number of cardiac surgeries, lower MPV values and higher GGT and TSH levels than Fontan patients with mild findings. In conclusion, Fontan patients showed higher liver enzymes (AST, ALT and GGT) than controls and Fontan patients with significant liver ultrasound findings had higher GGT and TSH concentrations than Fontan patients with mild findings.
肝脏并发症在接受Fontan手术的患者中很常见。这项观察性研究的目的是比较14岁以上接受Fontan手术的患者（病例组）和无症状的单纯非手术限制性室间隔缺损（VSD）患者（对照组）的人口统计学、临床和血液检测数据，并根据Fontan患者组的肝脏超声检查结果确定采血和肝病评分是否存在差异。肝脏检查结果分为轻度（正常或回声不均匀）和重度（表面结节状、小的高回声结节或肝癌）。74例患者（14例接受Fontan手术，60例患有限制性VSD）纳入研究。中位年龄为18（14 - 45）岁，41例为男性。Fontan手术患者的血小板计数、平均血小板体积（MPV）和血糖水平显著低于单纯非手术限制性VSD患者。相反，Fontan手术患者的肝酶[天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、γ-谷氨酰转移酶（GGT）]、N末端脑钠肽前体（NT-pro-BNP）和促甲状腺激素（TSH）浓度高于限制性VSD患者。14例接受Fontan手术且肝脏超声检查结果为重度的患者中有4例（29%），与肝脏检查结果为轻度的Fontan患者相比，其心脏手术次数更多、MPV值更低、GGT和TSH水平更高。总之，Fontan手术患者的肝酶（AST、ALT和GGT）高于对照组，肝脏超声检查结果为重度的Fontan患者的GGT和TSH浓度高于肝脏检查结果为轻度的Fontan患者。
