A Resected Hepatocellular Carcinoma after the Fontan Procedure

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  • Fontan手術後の鬱血肝を背景に発生した肝細胞癌の1切除例

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In postoperative course of the Fontan procedure for congenital heart disease, the hepatic venous congestion due to a chronic decrease in cardiac output gives rise to several potential problems. There have been some case reports of hepatocellular carcinoma after the Fontan procedure, but few resected cases have been reported. We herein describe a case of hepatocellular carcinoma developing with a background of hepatic congestion after the Fontan procedure. A 34-year-old man had undergone surgery in childhood and the Fontan procedure at age 19 for congenital tricuspid valve atresia. Hepatocellular carcinoma in segment 3 (S3) of the liver was identified 15 years after the procedure. Partial hepatectomy of S3 was performed. During the operation, we had some difficulties in controlling venous bleeding, because hepatic venous congestion had developed remarkably due to the influence of the hemodynamics caused by the Fontan procedure. In spite of the normal range of various preoperative markers for hepatic fibrosis, advanced fibrosis was observed, and the stage of the liver fibrosis was F3 pathologically. In patients with hepatocellular carcinoma developing after the Fontan procedure, surgery should be performed with an understanding of the associated clinical condition including specific hemodynamics.

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