warfarin and Situs-Inversus

Hepatocellular carcinoma (HCC) is a long-term complication of Fontan-associated liver disease (FALD). However, risk factors for HCC in patients with FALD remain unclear. This study aimed to identify factors associated with HCC development post-Fontan procedure.. We retrospectively examined 103 post-Fontan patients who underwent hepatic imaging at our institution. HCC incidence and patient characteristics were analyzed. A Cox proportional hazards model was used to identify risk factors for HCC.. The median interval between Fontan surgery and final hepatic imaging was 19.6 (1.0-37.7) years. Among 103 patients, nine developed HCC. The cumulative incidence rates of HCC at 10, 20, and 30 years postoperatively were 0%, 7%, and 13%, respectively. In the univariate analysis, age at Fontan surgery, situs inversus, and warfarin absence were associated with HCC occurrence. The multivariate analysis identified the warfarin absence (adjusted hazard ratio [aHR], 22.71; 95% confidence interval: 3.29-507.1; p = 0.0005) and situs inversus (aHR, 14.36; 95% confidence interval: 2.75-105.5; p = 0.002) as risk factors. The prevalence of situs inversus and the warfarin absence was 12% and 50%, respectively. The 20- and 30-year incidence rates of HCC among patients who received warfarin were 0% and 7%, respectively, while those among patients who did not receive warfarin were 14% and 21%, respectively. HCC incidence was significantly higher in the non-warfarin group than in the warfarin group (p = 0.006) and among patients with situs inversus than among those with situs solitus (p = 0.004).. Warfarin absence and situs inversus were associated with HCC development post-Fontan procedure.

Topics: Carcinoma, Hepatocellular; Fontan Procedure; Humans; Liver Neoplasms; Retrospective Studies; Situs Inversus; Warfarin

Topics: Adult; Aorta; Dextrocardia; Electrocardiography; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Pulmonary Artery; Situs Inversus; Transposition of Great Vessels; Tricuspid Valve; Warfarin

Topics: Dextrocardia; Embryo, Mammalian; Female; Humans; Infant, Newborn; Male; Pregnancy; Pregnancy Complications, Cardiovascular; Situs Inversus; Thrombosis; Warfarin