Arterialised hepatic nodules in the Fontan circulation: Hepatico-cardiac interactions
Arterialised hepatic nodules in the Fontan circulation: Hepatico-cardiac interactions
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DOI：
10.1016/j.ijcard.2010.05.047
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发表时间：
2011-09-15
影响因子：
3.5
通讯作者：
Veldtman, Gruschen R.
中科院分区：
文献类型：
--
作者：
Bryant, Timothy;Ahmad, Zaheer;Veldtman, Gruschen R.
高血管结节常见于肝静脉出口梗阻。它们在方潭环流中的性质和决定因素尚不清楚。我们回顾了连续27例Fontan患者的记录，这些患者在4年的时间里进行了计算机断层扫描（CT），检查动脉化结节和增强CT扫描时肝血流模式的改变，并将这些发现与心脏特征联系起来。患者平均年龄为24 +/- 5.8岁（范围16.7-39.8），平均Fontan持续时间为16.8 +/- 4.8年（范围7.3-28.7）。22例呈网状强化，4例呈带状强化，仅有1例呈正常强化。7例（26%）患者中位有4个（范围1-22）动脉化结节，平均大小为1.8厘米（范围0.5 - 3.2厘米）。所有结节均位于肝周缘，其外缘位于肝缘2 cm以内。结节患者的RA平均压力较高（18 mmHg +/- 5.6 vs. 13 mmHg +/- 4, p = 0.025），而他们的混合静脉饱和度和主动脉饱和度没有显著差异（70% +/- 11 vs. 67% +/- 9和92% +/- 10 vs. 94% +/- 4, p = 0.05）。死后组织学提示局灶性结节增生是潜在病理。结论肝血流异常和动脉化结节在方坦循环衰竭中是常见的。特别是当中心静脉压高时，很可能表明肝血流动脉化和门静脉相互剥夺。基本病理很可能是局灶性结节增生。2010爱思唯尔爱尔兰有限公司版权所有。
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. (C) 2010 Elsevier Ireland Ltd. All rights reserved.