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

Timothy Bryant, Zaheer Ahmad, Harry Millward-Sadler, Kashif Burney, Brian Stedman, Tim Kendall, Joseph Vettukattil, Marcus Haw, Anthony P. Salmon, Richard Cope, Nigel Hacking, David Breen, Nick Sheron, Gruschen R. Veldtman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

58 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)268-272
Number of pages5
JournalInternational Journal of Cardiology
Volume151
Issue number3
DOIs
Publication statusPublished - 15 Sep 2011
Externally publishedYes

Keywords

  • Focal nodular hyperplasia
  • Fontan
  • Hepatic nodules

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