. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Abstracts S323 650 Fontan-Associated Liver Disease (FALD)–Results from Shear Wave Elastography D. Zentner 1,* , K. Phan 1 , R. Gibson 2 , S. Sood 3 , A. Gorelik 4 , L. Grigg 1 , A. Nicoll 5 1 Cardiology Department, Royal Melbourne Hospital, Melbourne, Australia 2 Department of Radiology, Royal Melbourne Hospital, Melbourne, Australia 3 Department of Gastroenterology and Herpetology, Royal Melbourne Hospital, Melbourne, Australia 4 Epicentre, Royal Melbourne Hospital, Melbourne, Australia 5 Eastern Health Department of Gastroenterology, Melbourne, Australia Background and Aims: There is increasing clinical con- cern about morbidity and mortality associated with long-term hepatic damage in the setting of the Fontan circulation. Litera- ture describes abnormalities of biochemistry and imaging; but interpretation, utility of reference values from other patient cohorts and the true incidence of clinical liver disease remains unknown. We sought to assess Fontan patients with an imag- ing protocol using both hepatic ultrasound and ultrasound Shear wave elastography measured by acoustic radiation force impulse imaging (ARFI). Methodology and Results: 33 patients (F:M, 20:13) aged 28 (22–32.5) years with a Fontan circulation (atriopulmonary n = 16, lateral tunnel n = 2, extracardiac n = 15) a median (IQR) of 22 (15.5–27) years post Fontan operation were assessed. In almost ¾, ARFI values were > 1.78 m/s, the cirrhotic reference range in chronic Hepatitis C. In contrast to an understanding that liver damage is related to time post Fontan, we found no correlate with postoperative duration. ARFI values were statistically significantly different (p = 0.04) between patients with and without nodularity on ultrasound. Discussion and Conclusion: Clinical liver disease in Fontan patients is of concern for their health, life expectancy and heart transplant suitability. International guidelines do not stipulate mode and frequency of routine liver monitoring. This project aims to establish the usual values for ARFI and will follow patients for the potential occurrence of clinical end points (development of clinical liver disease, hepatocellular carcinoma, heart transplantation and death). http://dx.doi.org/10.1016/j.hlc.2017.06.651 651 Health Related Quality of Life in Children and Young Adults Following Congenital Heart Disease Surgery: a Meta-Analysis L. Akbar Ladak 1,* , J. Gullick 1 , B. Hasan 2 , R. Gallagher 1 1 The University of Sydney, Sydney, Australia 2 The Aga Khan University, Karachi, Pakistan Background: Health related quality of life (HRQOL) issues have become an increasing focus in the congenital heart dis- ease (CHD) population but the findings are inconsistent. We aimed to conduct a meta-analysis to explore HRQOL in CHD surgical children and young adults from both patients and parental report and to identify its predictors. Method: Medline, CINAHL and Embase were searched. Quantitative designs with samples of at least 80% surgical patients, mean age ≤ 24 years and had their HRQOL assessed at ≥ 1 year following CHD surgery were included in the anal- ysis. Gill and Feinstein’s 10 criteria were used for evaluating the studies. Data was analysed in RevMan 5.3 using random model. Result: 21 studies were included in the review which had utilised a generic and/or disease specific questionnaire (DSQ) with 4033 patients (median = 113) and 3070 parents (median = 60). The quality appraisal score ranged from 0 to 6 (median 1). This meta-analysis revealed that the HRQOL was lower in CHD compared to the healthy controls in all the domains for both self and parental reports. Physical function- ing had the largest standard mean difference of -0.60 (CI -0.83, -0.36). DSQ highlighted better HRQOL in simple compared to complex CHDs. Factors predictive of HRQOL postoperatively included clinical, operative and socio-demographic factors. Only one study reviewed was conducted in low-middle income coun- tries (LMIC). Conclusion: HRQOL in CHD surgical patients was sub- stantially lower than age matched controls, identifying that support from health care professionals is needed. HRQOL research needs to be conducted in LMICs. http://dx.doi.org/10.1016/j.hlc.2017.06.652 652 Health Related Quality Of Life in Postoperative Congenital Heart Patients: Experience from a Low Middle Income Country, Pakistan L. Ladak 1,* , B. Hasan 2 , J. Gullick 1 , K. Awais 2 , A. Abdullah 2 , R. Gallagher 1 1 The University of Sydney, Sydney, Australia 2 The Aga Khan University, Karachi, Pakistan Background: Health related quality of life (HRQOL) issues are common in postoperative congenital heart disease (CHD) patients and often need intervention. There is paucity of data from low/middle income countries (LMIC).