Your browser doesn't support javascript.
loading
Percutaneous liver biopsy in Fontan patients.
Srinivasan, Abhay; Guzman, Anthony K; Rand, Elizabeth B; Rychik, Jack; Goldberg, David J; Russo, Pierre A; Cahill, Anne Marie.
Afiliação
  • Srinivasan A; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Radiology 3NW47, Philadelphia, PA, 19104, USA. srinivasaa@email.chop.edu.
  • Guzman AK; Children Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA. srinivasaa@email.chop.edu.
  • Rand EB; Children Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA.
  • Rychik J; Children Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA.
  • Goldberg DJ; Department of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
  • Russo PA; Children Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA.
  • Cahill AM; Department of Cardiology, University of Pennsylvania Peralman School of Medicine, Philadelphia, PA, USA.
Pediatr Radiol ; 49(3): 342-350, 2019 03.
Article em En | MEDLINE | ID: mdl-30506328
BACKGROUND: Patients who have undergone the Fontan operation for palliation of congenital heart disease with single-ventricle pathophysiology are at high risk for developing progressive liver fibrosis. Pathological assessment from percutaneous liver biopsy is central to the management of Fontan-associated liver disease, but liver biopsy in this vulnerable population poses unique challenges and potential risks. OBJECTIVE: This retrospective study describes our experience with percutaneous liver biopsy performed to assess changes of Fontan-associated liver disease, with particular regard to procedural outcomes. MATERIALS AND METHODS: Data from liver biopsy procedure reports, pathology reports, cardiac angiography pressure measurements and laboratory values of patients with single ventricle heart disease after the Fontan operation who underwent ultrasound-guided percutaneous liver biopsy performed in interventional radiology at a pediatric tertiary care center during a 3-year period were retrospectively analyzed. RESULTS: Sixty-eight liver biopsies were performed in 67 patients (mean age: 20.2 years, range: 7.2-39 years). The technical success rate was 100%, and tissue was adequate for assessing liver disease in 100% of the procedures, including biopsies performed with a single pass. Anticoagulation was routinely suspended before biopsy, and no cardiac complications were encountered due to this suspension. A coaxial biopsy system using an 18-gauge (G) full-core instrument through a 17-G introducer trocar was most commonly used, in 41/68 cases (60%). The most common trough length was 2.3 cm, used in 37 cases (54%). One pass was made in 27 procedures (40%) and two passes in 30 (44%); tract embolization with gelatin sponge was performed in 52 (76%). The only complication was hemorrhage, which occurred in 5/68 (7.4%) of the biopsies, minor in four (5.9%) and major in one (1.5%) -- similar to rates reported for liver biopsy in non-Fontan patients. Hemorrhage had a delayed presentation in three of these five cases. Immediate post-biopsy hemoglobin decrease of ≥2 mg/dL showed a low sensitivity for hemorrhage. The mean Fontan pressure measured during cardiac angiography was 13.8 mmHg, and shunt pressures were not associated with an increased risk of hemorrhage. CONCLUSION: Percutaneous liver biopsy in Fontan patients can be performed safely with high technical success rates and without increased complication rates. Meticulous technique and close observation are recommended to reduce post-biopsy complications. The degree of right heart pressure elevation was not associated with hemorrhage.
Assuntos
Palavras-chave

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Ultrassonografia de Intervenção / Técnica de Fontan / Biópsia Guiada por Imagem / Cirrose Hepática Idioma: En Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Ultrassonografia de Intervenção / Técnica de Fontan / Biópsia Guiada por Imagem / Cirrose Hepática Idioma: En Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Estados Unidos