Transarterial chemoembolization for hepatocellular carcinoma in Fontan surgery patient

Abstract

We describe the case of a 41‐year‐old woman who developed a liver neoplasm due to previous Fontan surgery for a single ventricle anomaly and pacemaker implantation. She was admitted to our hospital for moderate ascites and she was affected by hepatocellular carcinoma treated by trans-arterial chemoembolization (TACE). Computed tomography showed features of chronic liver disease and 4 cm hepatic nodules with arterial enhancement. Laboratory analyses documented preserved liver function and increased levels of alpha-fetoprotein. TACE was performed obtaining complete necrosis at 4 weeks of follow up and significant reduction of alpha-fetoprotein after 2 months. The patient is currently in follow-up, being evaluated for further treatments and/or combined liver/heart transplantation. TACE is a therapeutic option for the treatment of patients with unresectable HCC and with severe heart disease, like those submitted to FS.

Repeated TACE in HCC after Fontan surgery and situs viscerum inversus: A case report

“…There are cases in the literature of TACE in Fontan surgery [ 11 ] but there have been no reports of TACE in SI in Fontan cases, the detailed organ and vascular anatomy of SI obtained from this case is important. This case will serve as a reference for successful treatment in future cases.…”

From congestive hepatopathy to hepatocellular carcinoma, how can we improve patient management?

“…Despite some cases of heart failure, the tolerance was good and positive results were observed . 93 The best approach for HCC has not been defined yet and combined liver-heart transplantation still has to be discussed. Currently, the prognosis of HCC-related to Fontan procedure is poor (1-year survival around 50%) and the management and surveillance of patients has to be improved.…”

“…Transarterial chemoembolizations were also offered in cases of HCC not eligible for surgery. Despite some heart failures, the tolerance was good and positive results were observed (93). The best approach of HCC has not been defined yet and the combined liver-heart transplantation still has to be discussed.…”