Pain Management With Bilateral Continuous Thoracic Paravertebral Block in a Patient With Fontan-Associated Hepatocellular Carcinoma Undergoing Hepatectomy

Maeda, Akito; Shibata, Sho; Okitsu, Kenta; Imada, Tatsuyuki; Takahashi, Ayako; Uchiyama, Akinori; Kamibayashi, Takahiko; Fujino, Yuji

doi:10.1097/aap.0000000000000316

Cited by 13 publications

(11 citation statements)

References 8 publications

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“…The study population is based on a case series that we have published previously [4]. In brief, all patients with a Fontan circulation and a diagnosis of HCC that were followed at 9 adult congenital heart disease centers in North America and Europe between January 1990 and December 2016 were included; some of these cases were also published as case reports [8][9][10][11][12][13][14][15][16][17][18]. Study approval was obtained from the institutional review boards of the participating sites and the need for written informed consent was waived.…”

Section: Study Design and Populationmentioning

confidence: 99%

Hepatocellular carcinoma and the Fontan circulation: Clinical presentation and outcomes

Possner

Gordon‐Walker

Egbe

et al. 2021

International Journal of Cardiology

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Section: Study Design and Populationmentioning

confidence: 99%

Hepatocellular carcinoma and the Fontan circulation: Clinical presentation and outcomes

Possner

Gordon‐Walker

Egbe

et al. 2021

International Journal of Cardiology

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“…Twenty-six studies including 65 patients with biopsy-proven HCC were selected for our main analysis: one prospective cohort, 12 six retrospective cohorts 5,6,9,[22][23][24] , five retrospective case series, 7,25-28 and 14 case reports. 10,18,[29][30][31][32][33][34][35][36][37][38][39][40] Eleven reports were from North America, seven from Asia, six from Europe, one from Australia, one from Turkey, and one from both North America and Europe (see Table S1). Four were multicenter studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

Hepatocellular carcinoma after Fontan surgery: A systematic review

Santiago

Téllez

Guerrero

et al. 2020

Hepatology Research

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Aim: Fontan surgery is often the procedure of choice for patients with congenital single effective ventricle. In the long term, elevated systemic venous pressure and chronic ischemia following this procedure could lead to advanced chronic liver disease and there is also a risk of hepatocellular carcinoma (HCC). This review systematically summarizes the characteristics and outcomes of this rare condition. Methods: PubMed and Embase databases were searched from inception to January 2020 for studies reporting on HCC after Fontan surgery. The factors analyzed were clinical presentation, histology, imaging findings, treatments, and survival. Our primary analysis was based on biopsy-proven HCC. Results: The records selected were 26 observational studies (19 case reports/case series and seven cohort studies) including 65 biopsy-proven HCC. Age at the time of HCC diagnosis ranged from 12 to 52 years, and 62% of the patients were female. Only one case occurred earlier than 10 years after Fontan surgery. Twenty patients had no imaging or histological evidence of liver cirrhosis and 78.3% had elevated α-fetoprotein levels. Advanced stage was the most common at diagnosis. The most frequent treatments were transarterial chemoembolization (n = 18) and surgery (n = 12). One-year survival was 50% and only four patients (6.2%) were under liver imaging surveillance. We also analyzed 17 patients with non-biopsy-proven HCC. Conclusions: After Fontan surgery, HCC usually occurs at least 10 years later and can develop in the absence of cirrhosis. Biopsy is mandatory to confirm the diagnosis. Patients were diagnosed at a late stage and survival outcomes were poor, highlighting a need for liver surveillance.

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“…The mean (range) age at first diagnosis of LC and HCC was 23 (13-34) and 31 (22-44) years, respectively. The mean (range) age at the first Fontan procedure was 8.2 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) years. The mean (range) period from the first Fontan procedure until the diagnosis of LC and/or HCC was 14.5 (5-24) and 21.6 (7-31) years, respectively.…”

Section: The 2nd Surveymentioning

confidence: 99%

Liver Cirrhosis and/or Hepatocellular Carcinoma Occurring Late After the Fontan Procedure　― A Nationwide Survey in Japan ―

Kuwabara

Niwa

Toyoda

et al. 2018

Circ J

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Background: Fontan-associated liver disease (FALD) is an important late complication involving liver dysfunction, such as liver cirrhosis (LC) and hepatocellular carcinoma (HCC), in patients undergoing the Fontan procedure. However, the prevalence, clinical manifestation, and methods of diagnosis of FALD are still not well established. Methods and Results:This study comprised 2 nationwide surveys in Japan. First, the prevalence of LC and/or HCC in patients undergoing the Fontan procedure was determined. Second, clinical manifestations in patients with LC and/or HCC were analyzed, along with data from blood tests, echocardiography, and right heart catheterization. In the 1st survey, of the 2,700 patients who underwent the Fontan procedure, 31 were diagnosed with LC and/or HCC (1.15%), and 5 died due to liver diseases (mortality: 0.19%). In the 2nd survey, data were collected from 17 patients (12 with LC, 2 with HCC, and 3 with LC+HCC. Of these 17 patients, 5 died (mortality: 29.4%). The mean age at diagnosis of LC and HCC was 23 and 31 years, respectively. Computed tomography followed by ultrasound was most frequently used for diagnosis. Blood tests revealed low platelet counts, increased hemoglobin, aspartate aminotransferase, γ-guanosine triphosphate, and total bilirubin levels, and an elevated international normalized ratio of prothrombin time.Conclusions: LC and/or HCC in patients undergoing the Fontan procedure were not rare late complications and were associated with high mortality rates.

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Pain Management With Bilateral Continuous Thoracic Paravertebral Block in a Patient With Fontan-Associated Hepatocellular Carcinoma Undergoing Hepatectomy

Cited by 13 publications

References 8 publications

Hepatocellular carcinoma and the Fontan circulation: Clinical presentation and outcomes

Hepatocellular carcinoma and the Fontan circulation: Clinical presentation and outcomes

Hepatocellular carcinoma after Fontan surgery: A systematic review

Liver Cirrhosis and/or Hepatocellular Carcinoma Occurring Late After the Fontan Procedure　― A Nationwide Survey in Japan ―

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Pain Management With Bilateral Continuous Thoracic Paravertebral Block in a Patient With Fontan-Associated Hepatocellular Carcinoma Undergoing Hepatectomy

Cited by 13 publications

References 8 publications

Hepatocellular carcinoma and the Fontan circulation: Clinical presentation and outcomes

Hepatocellular carcinoma and the Fontan circulation: Clinical presentation and outcomes

Hepatocellular carcinoma after Fontan surgery: A systematic review

Liver Cirrhosis and/or Hepatocellular Carcinoma Occurring Late After the Fontan Procedure ― A Nationwide Survey in Japan ―

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Product

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Liver Cirrhosis and/or Hepatocellular Carcinoma Occurring Late After the Fontan Procedure　― A Nationwide Survey in Japan ―