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The Liver in Heart Failure and Adults with Congenital Heart Disease

Lorena Millo1, Matthew Kappus2

  • 1Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.

Clinics in Liver Disease
|July 16, 2025
PubMed

Insights

Heart failure commonly causes liver disease, especially in congenital heart disease (CHD) patients. Fontan-associated liver disease (FALD) in single-ventricle CHD requires multidisciplinary management for better patient outcomes.

Area of Science:

  • Cardiology
  • Hepatology
  • Pediatric Congenital Heart Disease

Background:

  • Liver disease frequently complicates heart failure due to hepatic congestion and reduced cardiac output.
  • Congenital heart disease (CHD) patients face heightened risks of hepatic injury due to complex physiology and surgical interventions.
  • Single-ventricle CHD patients undergoing the Fontan procedure are particularly susceptible to Fontan-associated liver disease (FALD).

Purpose of the Study:

  • To highlight the challenges in screening and managing Fontan-associated liver disease (FALD).
  • To emphasize the need for a multidisciplinary approach in addressing liver disease within the context of CHD.
  • To deepen the understanding of the pathophysiology of liver disease in CHD patients.

Main Methods:

  • Review of existing literature on liver disease in heart failure and CHD.
  • Analysis of physiological factors contributing to hepatic injury in Fontan patients.
  • Discussion of current screening and management strategies for FALD.

Main Results:

  • FALD is a significant complication in single-ventricle CHD patients post-Fontan procedure.
  • Hepatic congestion and impaired perfusion are key mechanisms linking CHD to liver injury.
  • Current management of FALD presents considerable challenges.

Conclusions:

  • A coordinated, multidisciplinary approach is essential for effective FALD screening and management.
  • Further research is needed to improve understanding and treatment of liver disease in CHD.
  • Early recognition and intervention are crucial for improving long-term outcomes in FALD patients.

Keywords:
CirrhosisCongenital heart diseaseFontanHeart failureLiver disease

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