Routine Follow-Up Transjugular Liver Biopsy in Bi- and Univentricular CHD Patients—Technical Considerations and Safety

Background: Patients with Fontan palliation face a significant risk of developing congestive hepatopathy and Fontan-associated liver disease (FALD) due to hemodynamic shifts. Those with congenital heart defects (CHD) and prolonged elevation of central venous pressure (CVP) are also susceptible to liver alterations, potentially leading to cirrhosis. Liver fibrosis staging involves various modalities, including non-invasive scoring systems, elastography, and, in select cases, histological examination. Transjugular liver biopsy (TJLB) emerges as an alternative technique for the surveillance of liver disease, warranting its inclusion in the standard program of cardiac follow-up catheterization procedures.

Methods: During routine follow-up cardiac catheterization prompted by hemodynamic or clinical anomalies, four patients with Fontan circulation, aged between 16 and 26 years, alongside with three patients with congenital heart defects, underwent TJLB as part of their surveillance catheterization. The procedures were conducted under conscious sedation and local anesthesia without need for general anesthesia. Jugular access was secured at the liver site, and a 5 F multipurpose catheter was introduced into the liver veins. Subsequent to manual angiography for precise delineation of local hepatic venous anatomy, an exchange wire facilitated the placement of the bioptome, enabling three consecutive biopsies.

Results: No complications were encountered, notably absent were instances of perforation or bleeding. Technical success was achieved at a rate of 100%, with all acquired samples deemed suitable for histopathological assessment. The total additional procedure time amounted to less than 20 minutes.

Conclusion: TJLB presents itself as an appealing alternative for obtaining liver specimens within the realm of FALD and CHD management. It may be seamlessly integrated into routine cardiac hemodynamic assessments, affording a safe and minimally time-intensive option. Given its intravascular biopsy site, the risk of external bleeding or hematoma is significantly mitigated, even in the presence of elevated intrahepatic pressures and the frequently compromised coagulation profiles exhibited by these patients. Owing to its diminished complication rates in comparison to other methodologies, TJLB should be considered as a standard approach in these patient populations, warranting increased utilization in the follow-up of CHD patients. It stands as a procedure integrated into the same setting whenever hemodynamic evaluation of patients with congenital heart defects is needed.

Publication History

Article published online:
13 February 2024