Journal of Cardiac Surgery 2020;1–5

DOI: 10.1111/jocs.14951

© 2020 Wiley Periodicals LLC



Fontan venovenous collaterals and hepatic fibrosis


William N. Evans, MD, Ruben J. Acherman, MD, Gary A. Mayman, MD, Alvaro Galindo, MD, Abraham Rothman, MD, Michael L. Ciccolo, MD, Juan Lehoux, MD, Brody J. Winn, MD, Noel S. Yumiaco, MD, Humberto Restrepo, MD, MPH



William N. Evans, MD, Children's Heart Center

Nevada, 3006 S. Maryland Pkwy, Ste. 690, Las

Vegas, NV 89109.




Objective: We hypothesized that a relationship might exist between angiographically demonstrable, postFontan venovenous collaterals, and hepatic fibrosis.

Methods: We analyzed data from postFontan patients that underwent cardiac catheterization and transvenoushepatic biopsy procedures between March 2012

and March 2020. From innominate vein angiography, we determined those that either had or lacked venovenous collaterals. Additionally, we examined data from

postFontan patients that underwent hepatic ultrasound, shearwave elastography between January 2017 and March 2020.

Results: We identified 164 patients that met inclusion criteria. Of the 164, 101(62%) had venovenous collaterals. Of the 101 with collaterals, average total fibrosis

score (TFS) was 3.2 and the average rate of fibrosis progression was 0.28 vs an average TFS of 2.1 and an average fibrosis progression rate of 0.22 for those without

collaterals (P = .00001 and P = .01, respectively). Of the 101 with collaterals, oxygen saturation was 91% ± 4% vs 93% ± 3% (P = .048) without collaterals. Of the 164,

86 (52%) underwent ultrasound shearwave elastography. Of the 86 patients undergoing elastography, 50 (58%) were performed in those with collaterals, and

36 (42%) in those without collaterals. For the 50 with collaterals, average elastography values were 13.3 vs 11.2 kPa for the 36 without collaterals (P = .006). We found

No statistically significant differences for age at biopsy, Fontan duration, Fontantype, type of functional univentricle, laboratory, clinical, or hemodynamic values

Between those with or without collaterals.

Conclusions: The presence of angiographically demonstrated venovenous collaterals was associated with statistically, significantly more advanced liver fibrosis than

those without collaterals.


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