There are several known associations

find more between primary liver disease and concomitant CHD defects (Table 1). However, hepatic disease as a result of CHD is more common than cardiac disease associated with liver disease. Several CHD defects may lead to either left or right ventricular failure (Table 2). In these cases, hepatic dysfunction may ensue as a result of the primary cardiac defect or as a result of surgical palliation, especially in patients with single-ventricle physiology (e.g., tricuspid atresia). The mechanisms leading to hepatic dysfunction may be multifactorial (Table 3). As an example, hepatic dysfunction may result from a combination of passive venous congestion of the liver and hypoxia, with the latter being driven by the CHD or concomitant pulmonary disease. Volume overload and low cardiac output may lead to both congestive hepatopathy and hepatic Pexidartinib in vivo ischemia. Several factors may interact to lead

to end-stage liver disease. For example, patients with underlying liver disease (e.g., viral hepatitis, alcohol, or obesity) may be more susceptible to liver injury as a result of decreased functional mass.4 In addition, the presence of cardiac disease and subsequent passive congestion may itself predispose the liver to hepatic injury.5

Over time, cardiac cirrhosis (i.e., central vein to central vein bridging fibrosis and nodule formation) may develop and result in portal hypertension (PH) with ascites and varices. Hepatic consequences of passive venous congestion and low cardiac output are discussed MCE further. Right ventricular failure is a consequence of several defects and is reflected by hepatic zone 3 sinusoidal dilation and hemorrhagic necrosis. Zone 3 necrosis may also be caused by ischemia. As an example, CHD may be associated with elevated right atrial pressure resulting from left-to-right shunting through a septal defect with secondary pulmonary hypertension, univentricular physiology (e.g., tricuspid atresia), and with a failing systemic ventricle, which is a morphologic right ventricle (Tables 2 and 3). Restrictive physiology in the right ventricle (e.g., with repaired atrial septal defect [ASD] and tetralogy of Fallot [TOF]) also contributes to passive congestion. Narrowing of the venous pathway to the lungs (e.g., Fontan operation; see below) or in the inferior vena cava (after atrial baffle procedures for d-transposition of the great arteries) may contribute to hepatic venous congestion.