Yau Yuen Lo, Purlee Matthew S, Brinkley Lindsey M, Gupta Dipankar, Saulino David M, Lopez-Colon Dalia, Coppola John-Anthony, Rajderkar Dhanashree, Vyas Himesh
Congenital Heart Center, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
College of Medicine, University of Florida, Gainesville, FL 32610, USA.
Congenit Heart Dis. 2025;20(2):265-272. doi: 10.32604/chd.2025.065661. Epub 2025 Apr 30.
Patients with Fontan physiology are predisposed to congestive hepatopathy, progressive liver fibrosis, and end-stage liver disease. Ultrasound-based shear wave elastography (SWE) is a non-invasive tool to diagnose and monitor liver fibrosis. We sought to determine whether the degree of hemodynamic derangement prior to and after the Fontan operation is associated with increased liver stiffness measured by SWE.
A single-center retrospective study of patients with Fontan circulation who underwent ultrasound elastography between 2008 and 2024 was conducted. Liver stiffness was measured by SWE and reported as velocity in m/s. Hemodynamic assessment with cardiac catheterization and echocardiograms were collected before and after the Fontan operation. Data was analyzed as a continuous (linear regression model) and a dichotomous variable (-test).
78 post-Fontan ultrasound elastography studies performed in 56 patients were analyzed. Pre-Fontan hemodynamics included median effective pulmonary flow of 2.45 L/min/m [2.21, 3.16] ( = 0.46), ventricular end-diastolic pressure of 10 mmHg [8, 10.5] ( = 0.77), and median Glenn pressure of 12 mmHg [13, 15] ( = 0.83). Post-Fontan median systemic cardiac index was 2.80 L/min/m [2.4, 3.34] ( = 0.93), median ventricular end-diastolic pressure of 12 mmHg [13.5, 14] ( = 0.99), median systemic saturation of 93% [87, 96] ( = 0.77), median indexed pulmonary vascular resistance of 1.80 WU·m [1.49, 2.37] ( = 0.93), and median Fontan pressure of 18 mmHg [16, 21] ( = 0.86). No correlation was found between SWE and hemodynamics. On echocardiography, no correlation was found between SWE and systemic ventricular systolic function ( = 0.35) or degree of systemic atrioventricular valve regurgitation ( = 0.35).
The degree of liver stiffness by SWE in this cohort did not correlate with pre- and post-Fontan hemodynamics on cardiac catheterization, degree of ventricular dysfunction, or severity of atrioventricular valve regurgitation by echocardiography.
接受Fontan手术的患者易患充血性肝病、进行性肝纤维化和终末期肝病。基于超声的剪切波弹性成像（SWE）是一种用于诊断和监测肝纤维化的非侵入性工具。我们试图确定Fontan手术前后血流动力学紊乱程度是否与SWE测量的肝脏硬度增加相关。
对2008年至2024年间接受超声弹性成像检查的Fontan循环患者进行单中心回顾性研究。通过SWE测量肝脏硬度，并以米/秒的速度报告。在Fontan手术前后收集心脏导管检查和超声心动图的血流动力学评估数据。数据作为连续变量（线性回归模型）和二分变量（t检验）进行分析。
分析了56例患者进行的78次Fontan术后超声弹性成像研究。Fontan术前血流动力学指标包括：有效肺血流量中位数为2.45L/min/m[2.21,3.16]（P=0.46），心室舒张末期压力为10mmHg[8,10.5]（P=0.77），Glenn压中位数为12mmHg[13,15]（P=0.83）。Fontan术后全身心脏指数中位数为2.80L/min/m[2.4,3.34]（P=0.93），心室舒张末期压力中位数为12mmHg[13.5,14]（P=0.99），全身饱和度中位数为93%[87,96]（P=0.77），肺血管阻力指数中位数为1.80WU·m[1.49,2.37]（P=0.93），Fontan压中位数为18mmHg[16,21]（P=0.86）。未发现SWE与血流动力学之间存在相关性。在超声心动图检查中，未发现SWE与全身心室收缩功能（P=0.35）或全身房室瓣反流程度（P=0.35）之间存在相关性。
该队列中通过SWE测量的肝脏硬度程度与Fontan手术前后心脏导管检查的血流动力学、心室功能障碍程度或超声心动图检查的房室瓣反流严重程度均无相关性。
