{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T19:56:41Z","timestamp":1776455801218,"version":"3.51.2"},"reference-count":44,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Grant-in-Aid for Scientific Research","award":["KAKENHI-23K07372"],"award-info":[{"award-number":["KAKENHI-23K07372"]}]},{"name":"Grant-in-Aid for Scientific Research","award":["24fk0210128h0002"],"award-info":[{"award-number":["24fk0210128h0002"]}]},{"name":"Japan Agency for Medical Research and Development","award":["KAKENHI-23K07372"],"award-info":[{"award-number":["KAKENHI-23K07372"]}]},{"name":"Japan Agency for Medical Research and Development","award":["24fk0210128h0002"],"award-info":[{"award-number":["24fk0210128h0002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: This study aimed to investigate the prevalence of liver damage and its associated non-invasive markers and echocardiographic risk factors in patients who underwent surgery for congenital heart disease. Methods: This retrospective observational study was conducted at a single tertiary-care university hospital in Niigata, Japan. Of 142 patients (ventricular septal defect [VSD] n = 47, tetralogy of Fallot [TOF] n = 67, Fontan n = 28), 52.8% were male [median age: 22.7 years; VSD (24.3 years), TOF (24.0 years), and Fontan (12.5 years)]. Pediatric patients with liver diseases unrelated to congestive liver disease, such as viral hepatitis and alcoholic liver disease, were excluded. We compared non-invasive liver fibrosis age-invariant biomarkers, such as the aspartate aminotransferase-to-platelet ratio index (APRI), and various serum markers and echocardiographic parameters to assess the prevalence and predictors of hepatic fibrosis. Results: The Fontan circulation group had the highest APRI, followed by the TOF group, while the VSD group had a low risk of APRI elevation. Postoperative TOF patients required monitoring for cirrhosis progression. Inferior vena cava mobility was associated with echocardiographic parameters and fibrosis severity, along with a loss of respiratory variability. The limitations of other cardiac assessments were highlighted by poor anatomical measurements. Gamma-glutamyl transpeptidase (\u03b3-GTP) demonstrated strong discriminatory ability. The optimal cutoff value was 53.0 U\/L, suggesting its use as a clinical marker. Conclusions: Assessing fibrosis is crucial in CHD patients, especially those with late post-TOF repair findings. Non-invasive markers (APRI, \u03b3-GTP, and B-type natriuretic peptide), along with echocardiographic findings, may help detect fibrosis early, enabling timely intervention and improving long-term outcomes. Clinical trial registration: 2020-0199.<\/jats:p>","DOI":"10.3390\/children12091131","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:49:34Z","timestamp":1756309774000},"page":"1131","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Revisiting Hepatic Fibrosis Risk in Congenital Heart Disease: Insights from Non-Invasive Markers and Echocardiography"],"prefix":"10.3390","volume":"12","author":[{"given":"Fusako","family":"Yamazaki","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9135-3092","authenticated-orcid":false,"given":"Hiroteru","family":"Kamimura","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saori","family":"Endo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0789-2430","authenticated-orcid":false,"given":"Suguru","family":"Miida","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoaki","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaru","family":"Kumagai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naruhiro","family":"Kimura","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2618-7494","authenticated-orcid":false,"given":"Hiroyuki","family":"Abe","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Sakamaki","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7138-1785","authenticated-orcid":false,"given":"Takeshi","family":"Yokoo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masanori","family":"Tsukada","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 950-3198, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fujito","family":"Numano","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 950-3198, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2404-1128","authenticated-orcid":false,"given":"Akihiko","family":"Saitoh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 950-3198, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 950-3198, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuichi","family":"Shiraishi","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 950-3198, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masanori","family":"Tsuchida","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 950-3198, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinya","family":"Fujiki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Niigata University Medical and Dental Hospital, Niigata 950-3198, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9267-1017","authenticated-orcid":false,"given":"Takeshi","family":"Kashimura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Niigata University Medical and Dental Hospital, Niigata 950-3198, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4009-2359","authenticated-orcid":false,"given":"Takayuki","family":"Inomata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Niigata University Medical and Dental Hospital, Niigata 950-3198, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8484-1541","authenticated-orcid":false,"given":"Hirofumi","family":"Nonaka","sequence":"additional","affiliation":[{"name":"Department of Business Administration, Aichi Institute of Technology, Toyota 470-0356, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7182-4400","authenticated-orcid":false,"given":"Kenya","family":"Kamimura","sequence":"additional","affiliation":[{"name":"Department of General Medicine, School of Medicine, Niigata University, Niigata 950-3198, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsunori","family":"Tsuchiya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Yamanashi, Kofu 400-0016, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5439-635X","authenticated-orcid":false,"given":"Shuji","family":"Terai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/S0735-1097(01)01272-4","article-title":"Task force 1: The changing profile of congenital heart disease in adult life","volume":"37","author":"Warnes","year":"2001","journal-title":"J. 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