Surveillance of Fontan-associated liver disease: current standards and a proposal from the European Society of Paediatric Radiology Abdominal Task Force

Area of Science:

• Pediatric Cardiology
• Hepatology
• Radiology

Background:

• The Fontan procedure is a life-saving surgery for complex congenital heart disease, enabling patients to reach adulthood.
• Despite its success, Fontan-associated complications, including liver disease, significantly impact long-term patient health.
• Fontan-associated liver disease (FALD) is a progressive condition requiring specialized monitoring.

Purpose of the Study:

• To review the current understanding of Fontan-associated liver disease (FALD) pathophysiology.
• To outline the goals and methods for patient follow-up.
• To propose a consensus-based radiologic follow-up algorithm for FALD in Europe.

Main Methods:

• Literature review of Fontan-associated liver disease (FALD).
• Analysis of current follow-up strategies.
• Development of a consensus-based imaging algorithm by the European Society of Paediatric Radiology's Abdominal Task Force.

Main Results:

• The review synthesizes current knowledge on FALD's physiopathology.
• It highlights the importance of structured follow-up protocols.
• A proposed imaging algorithm for FALD surveillance in Europe is presented.

Conclusions:

• Fontan-associated liver disease (FALD) is a critical long-term complication requiring vigilant management.
• Standardized radiologic follow-up is essential for early detection and intervention.
• The proposed algorithm aims to optimize FALD monitoring across European centers.