More on Hepatocellular Carcinoma after the Fontan Procedure

To the Editor: The letter by Asrani et al. (May 2 issue)(1) reports cases of hepatocellular carcinoma in patients who have undergone Fontan palliation for univentricular hearts. Our practice includes yearly screening for adult patients who have undergone Fontan palliation, including imaging and testing of the alpha-fetoprotein level. We report on a 51-year-old man with a univentricular heart (double-inlet left ventricle) who underwent a classic atriopulmonary Fontan procedure in 1982. Progressive dyspnea, atrial arrhythmias, ascites, and pleural effusions developed in the context of normal ventricular systolic function. Evaluation of the liver, including biopsy and magnetic resonance imaging (MRI), showed congestive ...