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

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

hepatic nodules, fontan, focal nodular hyperplasia
0167-5273
268-272
Bryant, Timothy
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Ahmed, Z.
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Millward-Sadler, H.
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Burney, K.
c11d173c-fc5f-45e6-83fd-f1b4540a80bb
Stedman, B.
58aa88de-d498-4f8b-8d91-83545f28c7e5
Kendall, T.
3b6f47de-221c-41d2-b36f-04c3b80520c5
Vettukattil, J.
170920e9-33ca-4a2c-a51d-6cc225303944
Salmon, A.P.
b9365945-2a96-4f56-9ef6-e45aed2e2011
Haw, M.
05572348-43ba-4539-a713-0837ab2c3cee
Cope, R.
0011411c-8500-4165-9aa4-056a36c9d3a6
Hacking, N.
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Breen, D.
ae7bcf3b-188e-42a3-9c8d-9d2ff31dc2d6
Sheron, N.
cbf852e3-cfaa-43b2-ab99-a954d96069f1
Veldtman, G.R.
14a20a1e-ec10-42e8-ac51-f105969795d1
Bryant, Timothy
05bd12ef-e864-450e-96f5-addcc60c173d
Ahmed, Z.
625ec095-364c-4f51-9969-26965574d154
Millward-Sadler, H.
4ca48603-9633-4715-aff3-002e553375a7
Burney, K.
c11d173c-fc5f-45e6-83fd-f1b4540a80bb
Stedman, B.
58aa88de-d498-4f8b-8d91-83545f28c7e5
Kendall, T.
3b6f47de-221c-41d2-b36f-04c3b80520c5
Vettukattil, J.
170920e9-33ca-4a2c-a51d-6cc225303944
Salmon, A.P.
b9365945-2a96-4f56-9ef6-e45aed2e2011
Haw, M.
05572348-43ba-4539-a713-0837ab2c3cee
Cope, R.
0011411c-8500-4165-9aa4-056a36c9d3a6
Hacking, N.
b6287f0b-1b80-49a6-a01a-f52f9da671c8
Breen, D.
ae7bcf3b-188e-42a3-9c8d-9d2ff31dc2d6
Sheron, N.
cbf852e3-cfaa-43b2-ab99-a954d96069f1
Veldtman, G.R.
14a20a1e-ec10-42e8-ac51-f105969795d1

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), 268-272. (doi:10.1016/j.ijcard.2010.05.047). (PMID:20557964)

Record type: Article

Abstract

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

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Local EPrints ID: 158893
URI: https://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: 06 Jun 2018 13:07

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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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