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Arterialised hepatic nodules in the Fontan circulation: Hepatico-cardiac interactions

Record type: Article

Hypervascular nodules occur commonly when there is hepatic venous outlet obstruction. Their nature and determinants in the Fontan circulation is poorly understood. We reviewed the records of 27 consecutive Fontan patients who had computerized tomography scan (CT) over a 4 year period for arterialised nodules and alterations in hepatic flow patterns during contrast enhanced CT scans and related these findings to cardiac characteristics. Mean patient age was 24 ± 5.8 years, (range 16.7–39.8) and mean Fontan duration was 16.8 ± 4.8 years (range 7.3–28.7). Twenty-two patients demonstrated a reticular pattern of enhancement, 4 a zonal pattern and only 1 demonstrated normal enhancement pattern. Seven (26%) patients had a median of 4 (range 1–22) arterialised nodules, mean size 1.8 cm (range 0.5 to 3.2 cm). All nodules were located in the liver periphery, their outer aspect lying within 2 cm of the liver margin. Patients with nodules had higher mean RA pressures (18 mmHg ± 5.6 vs. 13 mmHg ± 4, p = 0.025), whereas their mixed venous saturation and aortic saturation was not significantly different (70% ± 11 vs. 67% ± 9 and 92% ± 10 vs. 94% ± 4, p > 0.05). Post-mortem histology suggests focal nodular hyperplasia is the underlying pathology. ConclusionsAbnormalities of hepatic blood flow and the presence of arterialised nodules are common in the failing Fontan circulation. They occur especially when central venous pressures are high, and very likely indicate arterialisation of hepatic blood flow and reciprocal portal venous deprivation. The underlying pathology is most likely focal nodular hyperplasia.

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Citation

Bryant, Timothy, Ahmed, Z., Millward-Sadler, H., Burney, K., Stedman, B., Kendall, T., Vettukattil, J., Salmon, A.P., Haw, M., Cope, R., Hacking, N., Breen, D., Sheron, N. and Veldtman, G.R. (2011) Arterialised hepatic nodules in the Fontan circulation: Hepatico-cardiac interactions International Journal of Cardiology, 151, (3), pp. 268-272. (doi:10.1016/j.ijcard.2010.05.047). (PMID:20557964).

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Published date: 15 September 2011
Keywords: hepatic nodules, fontan, focal nodular hyperplasia

Identifiers

Local EPrints ID: 158893
URI: http://eprints.soton.ac.uk/id/eprint/158893
ISSN: 0167-5273
PURE UUID: d946f770-b5cb-479b-aab5-f97f23a64e20
ORCID for N. Sheron: ORCID iD orcid.org/0000-0001-5232-8292

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Date deposited: 12 Nov 2010 14:30
Last modified: 18 Jul 2017 12:37

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Contributors

Author: Timothy Bryant
Author: Z. Ahmed
Author: H. Millward-Sadler
Author: K. Burney
Author: B. Stedman
Author: T. Kendall
Author: J. Vettukattil
Author: A.P. Salmon
Author: M. Haw
Author: R. Cope
Author: N. Hacking
Author: D. Breen
Author: N. Sheron ORCID iD
Author: G.R. Veldtman

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