288: Liver stiffness: a new, rapid and non-invasive method of central venous pressure evaluation in patients with congenital heart disease

Abstract

Transient elastography is a rapid, noninvasive and reproducible approach to assess liver fibrosis by measuring liver stiffness (LS). However, because the liver is enveloped by a capsule, any variation in parenchymal fluid content could theoretically affect LS. LS has been correlated to central venous pressure (CVP) in an animal model. We aimed to determine the correlation between LS and CVP in children and adults with congenital heart disease. In this ongoing prospective study, all patients referred for right heart catheterization were included. Measurements of mean right atrial pressure were obtained under general anesthesia (Fi02=21%) using an Optitorque 5 French catheter. The patients underwent 10 LS measurements (median value taken as representive) by transient elastography (Fibroscanâ, Echosens, France) within the 24 hours before catheterization. The results of LS are expressed in kilopascals (kPa). Eleven children (mean age=8±6 yo, 54% male) and 6 adults (mean age=34±17 yo, 66% male) have been included so far. Catheterism indications were pulmonary angioplasty (n=5), Melody valve implantation (n=1), fenestration occlusion after a Fontan procedure (n=1) and pre operative assessement of a complex congenital heart defect (n=10). Mean right atrial pressure was 9,1±3,9 mmHg and mean LS was 8,4±4,2 kPa. Correlation between LS and mean right atrial pressure was excellent for these first 17 patients (r=0,87). Liver stiffness is a new, rapid and reliable method to evaluate CVP in patients with congenital heart disease. This non invasive parameter could potentially be usefull for patients in whom CVP play a key role, especially in patients with a Fontan circulation.