At autopsy, hepatic fibrosis was commonly observed in patients who had undergone the Fontan operation. Portal fibrosis has been previously unrecognized in this population. Significant portal fibrosis occurred in most who died soon after the Fontan procedure and was associated with pre-Fontan morbidity. Hepatic disease in the single-ventricle population is multifactorial and may begin before the Fontan operation.

Although the incidence of coronary abnormalities is greater in patients with mitral hypoplasia and aortic atresia, in this study there was no apparent difference in perfusion of the right ventricle among the anatomic subgroups of hearts with hypoplastic left heart syndrome.

SUMMARY In cultured cells, infection by Group B coxsackieviruses (CVB) is mediated by the coxsackievirus and adenovirus receptor (CAR), but the importance of this molecule in CVB disease has not been determined. We used tissue-specific CAR gene deletion to generate mice that lacked CAR within each of two major CVB target organs, the pancreas and heart. Deletion of CAR from the pancreas resulted in a 1000-fold reduction in virus titers within the pancreas during infection, and a significant reduction in virus-induced tissue damage and inflammation. Similarly, cardiomyocyte-specific CAR deletion resulted in a 100-fold reduction in virus titer within the heart, and a marked reduction in cytokine production and histopathology. Although primary cardiomyocytes from control animals were susceptible to virus infection, CAR-deficient cardiomyocytes resisted infection in vitro. These results demonstrate a critical function for CAR in the pathogenesis of CVB infection in vivo, and in virus tropism for the heart and pancreas.