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Platelet count and abdominal dynamic CT are useful in predicting and screening for gastroesophageal varices after
Yoshiharu Isoura1, Akira Yamamoto2, Yuki Cho1
1Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan.
Insights
Gastroesophageal varices (GEVs) occur in Fontan surgery patients. A low platelet count (<119 × 10^9/L) predicts GEVs, prompting CT screening for these important complications.
Area of Science:
- Cardiology
- Gastroenterology
- Radiology
Background:
- Patients undergoing Fontan surgery for complex cardiac anomalies face risks of liver and gastrointestinal issues.
- Gastroesophageal varices (GEVs) are a potential complication, but their prevalence and predictors remain unclear.
Purpose of the Study:
- To determine the occurrence of GEVs in patients post-Fontan surgery.
- To identify parameters that predict the development of GEVs in this population.
Main Methods:
- Retrospective analysis of 27 patients post-Fontan surgery using abdominal dynamic computed tomography (CT).
- Radiological findings of GEVs and extraintestinal complications were evaluated by blinded radiologists.
- Statistical analysis correlated demographic and biochemical parameters with GEV presence.
Main Results:
- Dynamic CT identified gastric varices in 11.1%, esophageal varices in 3.7%, and gastrorenal shunts in 18.5%.
- All gastric varices were associated with gastrorenal shunts and confirmed endoscopically.
- A platelet count below 119 × 10^9/L was a significant predictor of GEVs (AUC 0.946, 100% sensitivity, 87% specificity).
Conclusions:
- GEVs are significant complications in Fontan procedure patients and require attention.
- Low platelet counts (<119 × 10^9/L) can indicate the need for abdominal dynamic CT screening to detect GEVs and associated shunts.
Objective:
Patients who undergo Fontan surgery for complex cardiac anomalies are prone to developing liver and gastrointestinal complications. In particular, gastroesophageal varices (GEVs) can occur, but their prevalence is unknown. We aimed to elucidate the occurrence of GEVs and the predicting parameters of GEVs in these patients.
Materials And Methods:
Twenty-seven patients (median age, 14.8 years; median time since surgery, 12.9 years) who had undergone the Fontan surgery and were examined by abdominal dynamic computed tomography (CT) for the routine follow-up were included in the study. Radiological findings including GEVs and extraintestinal complications were retrospectively evaluated by experienced radiologists in a blinded manner. Relationships between blood-biochemical and demographic parameters and the presence of GEVs were statistically analyzed.
Results:
Dynamic CT revealed gastric varices (n = 3, 11.1%), esophageal varices (n = 1, 3.7%), and gastrorenal shunts (n = 5, 18.5%). All patients with gastric varices had gastrorenal shunts. All gastric varices were endoscopically confirmed as being isolated and enlarged, with indications for preventive interventional therapy. A platelet count lower than 119 × 109 /L was identified as a predictor of GEV (area under the receiver operating curve, 0.946; sensitivity, 100%; and specificity, 87%).
Conclusions:
GEVs are important complications that should not be ignored in patients who have undergone a Fontan procedure. Platelet counts lower than 119 × 109 /L may help to prompt patient screening by using abdominal dynamic CT to identify GEVs and their draining collateral veins in these patients.
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