Related Experiment Video
Updated: Aug 11, 2026
09:37
Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats
Published on: August 1, 2018
Beyond Passive Congestion: The Inflammatory Gut-Liver Axis in Fontan Circulation
Ashish H Shah1,2, Amir Ravandi3
1Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. Ashish.Shah@umanitoba.ca.
Pediatric Cardiology
|August 10, 2026
Summary
Fontan circulation involves more than passive congestion; it
Area of Science:
- Cardiology
- Hepatology
- Immunology
Background:
- Fontan circulation traditionally viewed as passive venous congestion.
- Emerging multi-omic data suggest a broader inflammatory gut-liver-heart axis.
Purpose of the Study:
- To propose that hepatic congestion in Fontan circulation is biologically active.
- To integrate multi-omic findings into a unified hypothesis of Fontan-associated pathophysiology.
Main Methods:
- Integration of metabolomics, lipidomics, microbiome analysis, and cytokine profiling.
- Analysis of the tryptophan-kynurenine pathway and its metabolites.
- Review of existing multi-omic data in the context of Fontan physiology.
Main Results:
- Hepatic congestion in Fontan circulation is characterized by active biological processes.
- Key pathways implicated include bile acid dysregulation, short-chain fatty acid perturbation, and mitochondrial stress.
- Inflammatory signaling (IFN-γ/IP-10) and SDF-1α elevation are prominent.
- Tryptophan-kynurenine pathway activation is observed.
Conclusions:
- These active biological processes may form a feed-forward loop.
- This loop contributes to frailty, impaired exercise capacity, Fontan-associated liver disease, and multiorgan dysfunction.
- Further longitudinal and interventional studies are required to determine reversibility.
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