Our Summary

This study looked at a method for monitoring a liver disease often found in patients with a specific type of heart disease, called Fontan associated liver disease (FALD). This liver condition is due to the effects of Fontan circulation, a type of blood flow that can occur following certain heart surgeries, which can lead to liver damage. The research involved looking at the results of a procedure called a transjugular liver biopsy (TJLB) in patients with this heart condition over a four year period.

In this procedure, a small sample of liver tissue is taken through the jugular vein in the neck. The team wanted to see if there was a connection between the results of these liver biopsies and other measurements taken at the same time.

They found that this biopsy method was successful in all 125 patients they studied, with only a few complications, all of which were avoidable and didn’t have long-term effects. The method also had a lower complication rate than traditional techniques. They also found that patients with Fontan circulation often have abnormal blood vessels, and this should be checked before the biopsy.

Most importantly, the biopsy results were significantly linked to the average pressure in the Fontan circuit, the time since the Fontan procedure, and the cardiac index (a measure of heart function). Thus, the liver biopsy can provide important information about the health of patients with this type of heart disease.

FAQs

  1. What is the purpose of a transjugular liver biopsy (TJLB) in patients with Fontan associated liver disease (FALD)?
  2. What were the results and findings of the study on the use of TJLB in patients with FALD?
  3. How does the TJLB method compare to traditional techniques in terms of complication rates?

Doctor’s Tip

A helpful tip a doctor might give a patient about liver biopsy is to follow all pre-procedure instructions carefully, such as fasting before the procedure and stopping any blood-thinning medications as advised. After the procedure, it is important to follow post-procedure care instructions, such as avoiding strenuous activities and monitoring for any signs of infection or bleeding at the biopsy site. It is also important to follow up with your doctor to discuss the results of the biopsy and any further steps that may be needed for your liver health.

Suitable For

Patients who are typically recommended for a liver biopsy include those with suspected liver disease, such as liver inflammation, fibrosis, cirrhosis, or fatty liver disease. Liver biopsy may also be recommended for patients with unexplained liver enzyme abnormalities, abnormal liver imaging results, or to monitor the progression of a known liver disease.

In the case of Fontan associated liver disease (FALD), patients with Fontan circulation following heart surgeries may be recommended for a liver biopsy to assess the extent of liver damage caused by the abnormal blood flow and to monitor the progression of the liver disease. The study mentioned above highlights the importance of liver biopsy in patients with Fontan circulation to provide valuable information about their liver health and to guide treatment decisions.

Timeline

Before the liver biopsy:

  • Patient is diagnosed with Fontan associated liver disease (FALD) due to Fontan circulation
  • Patient undergoes various tests and assessments to determine the severity of the liver disease
  • Patient is informed about the liver biopsy procedure and its potential risks and benefits

During the liver biopsy:

  • Patient is prepared for the procedure, which involves taking a small sample of liver tissue through the jugular vein in the neck
  • Procedure is performed successfully with few complications, all of which are avoidable and temporary
  • Biopsy results are collected and analyzed to assess the severity of the liver disease and its connection to other measurements

After the liver biopsy:

  • Results of the biopsy show a significant link to the average pressure in the Fontan circuit, time since the Fontan procedure, and cardiac index
  • Patient’s treatment plan may be adjusted based on the biopsy results and other assessments
  • Patient is monitored for any complications or changes in liver health following the biopsy
  • Patient may undergo additional testing or procedures as needed to manage the liver disease and its effects on their overall health.

What to Ask Your Doctor

Some questions a patient should ask their doctor about liver biopsy for Fontan associated liver disease include:

  1. What is the purpose of the liver biopsy in my case?
  2. How will the biopsy be performed and what can I expect during the procedure?
  3. Are there any risks or complications associated with the liver biopsy?
  4. How will the results of the biopsy be used to manage my condition?
  5. What other tests or measurements will be taken at the same time as the liver biopsy?
  6. How often will I need to undergo liver biopsies as part of my care plan?
  7. Are there any specific preparations I need to make before the liver biopsy?
  8. How soon will I receive the results of the biopsy and how will they be communicated to me?
  9. Are there any alternative methods for assessing my liver health that could be considered?
  10. How will the information from the liver biopsy impact my overall treatment plan for Fontan associated liver disease?

Reference

Authors: Borquez AA, Silva-Sepulveda J, Lee JW, Vavinskaya V, Vodkin I, El-Sabrout H, Towbin R, Perry JC, Moore JW, El-Said HG. Journal: Int J Cardiol. 2021 Apr 1;328:83-88. doi: 10.1016/j.ijcard.2020.11.037. Epub 2020 Dec 2. PMID: 33278420