Two-dimensional shear wave elastography in Fontan-associated liver disease: a narrative review

Area of Science:

• Cardiology
• Hepatology
• Medical Imaging

Background:

• Single ventricle congenital heart defects necessitate complex surgical repairs, including the Fontan operation.
• The Fontan operation, while crucial for cardiac function, is linked to long-term liver complications known as Fontan-associated liver disease (FALD).
• Liver biopsy is the current gold standard for diagnosing FALD, but it is invasive.

Purpose of the Study:

• To review the current evidence on ultrasound-based shear wave elastography (SWE) for assessing liver stiffness in FALD.
• To discuss the applications, technical challenges, and limitations of using SWE in FALD management.
• To highlight factors confounding SWE interpretation in FALD patients.

Main Methods:

• Narrative review of existing literature on SWE and FALD.
• Analysis of studies investigating SWE as a non-invasive tool for liver stiffness measurement.
• Examination of serological, imaging, and histopathological parameters in conjunction with SWE.

Main Results:

• SWE is being explored as a non-invasive method to evaluate liver stiffness in FALD.
• Technical challenges and limitations exist for the widespread clinical implementation of SWE in FALD.
• Hepatic congestion and the absence of FALD-specific stiffness thresholds are significant confounding factors.

Conclusions:

• SWE holds potential as an adjunct diagnostic tool for FALD, complementing traditional methods.
• Standardized protocols for SWE acquisition and interpretation are crucial for reliable FALD assessment.
• Further research is needed to overcome limitations and validate SWE for clinical use in FALD.