Hepatic stiffness in the bidirectional cavopulmonary circulation: The Liver Adult-Pediatric-Congenital-Heart-Disease Dysfunction Study group

Shaija S. Kutty, Ming Zhang, David Alan Danford, Rimsha Hasan, Kim F Duncan, John Dale Kugler, Ruben Quiros, Shelby Kutty

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11 Citations (Scopus)

Abstract

Objectives We hypothesized that hepatic injury in single-ventricle CHD has origins that predate the Fontan operation. We aimed to measure hepatic stiffness using ultrasound and shear wave elastography (SWE) in a bidirectional cavopulmonary connection (BCPC) cohort. Methods Subjects were prospectively recruited for real-time, hepatic, ultrasound-SWE for hepatic stiffness (kPa) and echocardiography. Doppler velocities, a velocity-time integral, flow volume, and resistive index, pulsatility index, and acceleration index were measured in celiac and superior mesenteric arteries, and in the main portal vein (MPV). Comparisons were made among subjects who had BCPC, subjects who were healthy, and a cohort of patients who had undergone the Fontan procedure. Results Forty subjects (20 patients who had BCPC; 20 age- and gender-matched control subjects) were studied. The hepatic stiffness in BCPC was elevated, compared with that in control subjects (7.2 vs 5.7 kPa; P =.039). Patients who had BCPC had significantly higher celiac artery resistive index (0.9 vs 0.8; P =.002); pulsatility index (2.2 vs 1.7; P =.002); and systolic-diastolic flow ratio (10.1 vs 5.9; P =.002), whereas the superior mesenteric artery acceleration index (796 vs 1419 mL/min in control subjects; P =.04) was lower. An elevated resistive index (0.42 vs 0.29; P =.002) and pulsatility index (0.55 vs 0.35; P =.001) were seen in MPV, whereas MPV flow was reduced (137.3 vs 215.7 mL/min in control subjects; P =.036). A significant correlation was found for hepatic stiffness with right atrial pressure obtained at catheterization (P =.002). Comparison with patients who underwent the Fontan procedure showed patients who had BCPC had lower hepatic stiffness (7.2 vs 15.6 kPa; P <.001). Conclusions Hepatic stiffness is increased with BCPC physiology, and this finding raises concerns that hepatopathology in palliated, single-ventricle CHD is not exclusively attributable to Fontan physiology. Hepatic stiffness measurements using SWE are feasible in this young population, and the technique shows promise as a means for monitoring disease progression.

Original languageEnglish (US)
Pages (from-to)678-684
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume151
Issue number3
DOIs
StatePublished - Mar 1 2016

Fingerprint

Liver Circulation
Heart Diseases
Pediatrics
Liver
Fontan Procedure
Elasticity Imaging Techniques
Portal Vein
Superior Mesenteric Artery
Celiac Artery
Atrial Pressure
Prednisolone
Catheterization
Abdomen
Echocardiography
Disease Progression

Keywords

  • Fontan procedure
  • bidirectional cavopulmonary anastomosis
  • congenital heart disease
  • hepatic stiffness
  • shear wave elastography

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{e10c36955b04499d8084106bf7a77d5a,
title = "Hepatic stiffness in the bidirectional cavopulmonary circulation: The Liver Adult-Pediatric-Congenital-Heart-Disease Dysfunction Study group",
abstract = "Objectives We hypothesized that hepatic injury in single-ventricle CHD has origins that predate the Fontan operation. We aimed to measure hepatic stiffness using ultrasound and shear wave elastography (SWE) in a bidirectional cavopulmonary connection (BCPC) cohort. Methods Subjects were prospectively recruited for real-time, hepatic, ultrasound-SWE for hepatic stiffness (kPa) and echocardiography. Doppler velocities, a velocity-time integral, flow volume, and resistive index, pulsatility index, and acceleration index were measured in celiac and superior mesenteric arteries, and in the main portal vein (MPV). Comparisons were made among subjects who had BCPC, subjects who were healthy, and a cohort of patients who had undergone the Fontan procedure. Results Forty subjects (20 patients who had BCPC; 20 age- and gender-matched control subjects) were studied. The hepatic stiffness in BCPC was elevated, compared with that in control subjects (7.2 vs 5.7 kPa; P =.039). Patients who had BCPC had significantly higher celiac artery resistive index (0.9 vs 0.8; P =.002); pulsatility index (2.2 vs 1.7; P =.002); and systolic-diastolic flow ratio (10.1 vs 5.9; P =.002), whereas the superior mesenteric artery acceleration index (796 vs 1419 mL/min in control subjects; P =.04) was lower. An elevated resistive index (0.42 vs 0.29; P =.002) and pulsatility index (0.55 vs 0.35; P =.001) were seen in MPV, whereas MPV flow was reduced (137.3 vs 215.7 mL/min in control subjects; P =.036). A significant correlation was found for hepatic stiffness with right atrial pressure obtained at catheterization (P =.002). Comparison with patients who underwent the Fontan procedure showed patients who had BCPC had lower hepatic stiffness (7.2 vs 15.6 kPa; P <.001). Conclusions Hepatic stiffness is increased with BCPC physiology, and this finding raises concerns that hepatopathology in palliated, single-ventricle CHD is not exclusively attributable to Fontan physiology. Hepatic stiffness measurements using SWE are feasible in this young population, and the technique shows promise as a means for monitoring disease progression.",
keywords = "Fontan procedure, bidirectional cavopulmonary anastomosis, congenital heart disease, hepatic stiffness, shear wave elastography",
author = "Kutty, {Shaija S.} and Ming Zhang and Danford, {David Alan} and Rimsha Hasan and Duncan, {Kim F} and Kugler, {John Dale} and Ruben Quiros and Shelby Kutty",
year = "2016",
month = "3",
day = "1",
doi = "10.1016/j.jtcvs.2015.09.079",
language = "English (US)",
volume = "151",
pages = "678--684",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Hepatic stiffness in the bidirectional cavopulmonary circulation

T2 - The Liver Adult-Pediatric-Congenital-Heart-Disease Dysfunction Study group

AU - Kutty, Shaija S.

AU - Zhang, Ming

AU - Danford, David Alan

AU - Hasan, Rimsha

AU - Duncan, Kim F

AU - Kugler, John Dale

AU - Quiros, Ruben

AU - Kutty, Shelby

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Objectives We hypothesized that hepatic injury in single-ventricle CHD has origins that predate the Fontan operation. We aimed to measure hepatic stiffness using ultrasound and shear wave elastography (SWE) in a bidirectional cavopulmonary connection (BCPC) cohort. Methods Subjects were prospectively recruited for real-time, hepatic, ultrasound-SWE for hepatic stiffness (kPa) and echocardiography. Doppler velocities, a velocity-time integral, flow volume, and resistive index, pulsatility index, and acceleration index were measured in celiac and superior mesenteric arteries, and in the main portal vein (MPV). Comparisons were made among subjects who had BCPC, subjects who were healthy, and a cohort of patients who had undergone the Fontan procedure. Results Forty subjects (20 patients who had BCPC; 20 age- and gender-matched control subjects) were studied. The hepatic stiffness in BCPC was elevated, compared with that in control subjects (7.2 vs 5.7 kPa; P =.039). Patients who had BCPC had significantly higher celiac artery resistive index (0.9 vs 0.8; P =.002); pulsatility index (2.2 vs 1.7; P =.002); and systolic-diastolic flow ratio (10.1 vs 5.9; P =.002), whereas the superior mesenteric artery acceleration index (796 vs 1419 mL/min in control subjects; P =.04) was lower. An elevated resistive index (0.42 vs 0.29; P =.002) and pulsatility index (0.55 vs 0.35; P =.001) were seen in MPV, whereas MPV flow was reduced (137.3 vs 215.7 mL/min in control subjects; P =.036). A significant correlation was found for hepatic stiffness with right atrial pressure obtained at catheterization (P =.002). Comparison with patients who underwent the Fontan procedure showed patients who had BCPC had lower hepatic stiffness (7.2 vs 15.6 kPa; P <.001). Conclusions Hepatic stiffness is increased with BCPC physiology, and this finding raises concerns that hepatopathology in palliated, single-ventricle CHD is not exclusively attributable to Fontan physiology. Hepatic stiffness measurements using SWE are feasible in this young population, and the technique shows promise as a means for monitoring disease progression.

AB - Objectives We hypothesized that hepatic injury in single-ventricle CHD has origins that predate the Fontan operation. We aimed to measure hepatic stiffness using ultrasound and shear wave elastography (SWE) in a bidirectional cavopulmonary connection (BCPC) cohort. Methods Subjects were prospectively recruited for real-time, hepatic, ultrasound-SWE for hepatic stiffness (kPa) and echocardiography. Doppler velocities, a velocity-time integral, flow volume, and resistive index, pulsatility index, and acceleration index were measured in celiac and superior mesenteric arteries, and in the main portal vein (MPV). Comparisons were made among subjects who had BCPC, subjects who were healthy, and a cohort of patients who had undergone the Fontan procedure. Results Forty subjects (20 patients who had BCPC; 20 age- and gender-matched control subjects) were studied. The hepatic stiffness in BCPC was elevated, compared with that in control subjects (7.2 vs 5.7 kPa; P =.039). Patients who had BCPC had significantly higher celiac artery resistive index (0.9 vs 0.8; P =.002); pulsatility index (2.2 vs 1.7; P =.002); and systolic-diastolic flow ratio (10.1 vs 5.9; P =.002), whereas the superior mesenteric artery acceleration index (796 vs 1419 mL/min in control subjects; P =.04) was lower. An elevated resistive index (0.42 vs 0.29; P =.002) and pulsatility index (0.55 vs 0.35; P =.001) were seen in MPV, whereas MPV flow was reduced (137.3 vs 215.7 mL/min in control subjects; P =.036). A significant correlation was found for hepatic stiffness with right atrial pressure obtained at catheterization (P =.002). Comparison with patients who underwent the Fontan procedure showed patients who had BCPC had lower hepatic stiffness (7.2 vs 15.6 kPa; P <.001). Conclusions Hepatic stiffness is increased with BCPC physiology, and this finding raises concerns that hepatopathology in palliated, single-ventricle CHD is not exclusively attributable to Fontan physiology. Hepatic stiffness measurements using SWE are feasible in this young population, and the technique shows promise as a means for monitoring disease progression.

KW - Fontan procedure

KW - bidirectional cavopulmonary anastomosis

KW - congenital heart disease

KW - hepatic stiffness

KW - shear wave elastography

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U2 - 10.1016/j.jtcvs.2015.09.079

DO - 10.1016/j.jtcvs.2015.09.079

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JO - Journal of Thoracic and Cardiovascular Surgery

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