Objectives. Chronic congestion and altered venous flow may lead to structural and functional changes of the liver.
It was the aim of this study to judge intraindividual fluctuation of laboratory tests with increasing postoperative time interval and their correlation to hepatic sonographic and hemodynamic findings.
Methods. In a cross-sectional study 76 patients aged 40 to 315 months (mean follow-up 107+-38 months) were included; 14 patients presented with ascites, 11 with protein-losing enteropathy.
Results. Elevation of the y-glutamyltransferase level was present in 79% (increasing form 33% 4 years before). Aspartat/alanin transaminase level were only mildly elevated in 57% and 17%, respectively, with slightly increase during follow-up. There was no correlation to hemodynamic parameters except a significant correlation between y-glutamyltransferase level and pulmonary artery mean pressure (p<0.05) and systemic ventricular enddiastolic pressure (p<0.01). Hepatic sonography in patients with situs solitus revealed hepatomegaly in 6/27 and splenomegaly in 11/27 patients; increased echogenicity, inhomogeneity or liver surface nodularity were present in 12/27 patients (133+-37 months postoperatively). Doppler sonography revealed a flat wave form of portal venous flow in patients with y-glutamyltransferase level > 100U/l; the maximum portal flow velocity was significantly decreased in patients with ascites.
Conclusion. Evaluation of liver function revealed persistent elevation and further increase of y-glutamyltransferase during long-term follow-up. There was no compromise of synthetic function. Sonographic structural abnormalities were found with increasing time interval since TCPC. Hepatic changes will become an increasingly important aspect during long-term follow-up in patients after Fontan procedure even in presence of ideally hemodynamic parameters.