The Fontan procedure has gained acceptance and achieved excellent short-term outcomes, it has become evident that most post-Fontan patients develop hepatic fibrosis and even cirrhosis over time, referred to as Fontan-associated liver disease (FALD). FALD is in the spectrum of congestive hepatopathy, related at least in part to chronically elevated central venous pressures (CVPs) and a lack of pulsatility, resulting in passive venous congestion and impaired hepatic blood flow.

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