Chronic liver disease (CLD) in children can sometimes lead to complications in other parts of the body, including the heart. The primary purpose of this observational study is to assess the presence and type of cardiac problems in children who have been diagnosed with chronic liver disease.

Researchers will observe children under the age of 18 who are receiving care at the gastroenterology and hepatology unit at Assiut University Children Hospital. Participants will undergo standard medical evaluations to check both their liver and heart health.

These evaluations include:

• A detailed medical history and thorough physical examination
• Routine blood tests to check liver function, kidney function, coagulation, and electrolytes
• Abdominal imaging, such as an ultrasound, to look at the liver.
• An electrocardiogram (ECG) to check the heart's electrical activity and rhythm, including measuring the QTc interval.
• An echocardiogram to look at the structure of the heart and check how well its chambers and valves are functioning.

The study aims to identify specific heart conditions that can be associated with severe liver disease, such as portopulmonary hypertension, cirrhotic cardiomyopathy (changes in the heart muscle's function), and electrical repolarization abnormalities. Children who already have known congenital heart disease or a history of other heart problems will not be included in the study.

Chronic liver disease (CLD) in the pediatric age group involves progressive destruction and regeneration of liver parenchyma. The etiology in children encompasses a broad spectrum of disorders, including infections, autoimmune hepatitis, viral hepatitis, Wilson's disease, and biliary atresia. Prognosis and treatment are heavily influenced by the underlying etiology, necessitating thorough clinicopathological evaluation.

Among the severe reported complications of CLD, such as portal hypertension, malnutrition, and hepatorenal syndrome, cardiac complications are highly significant. This study specifically investigates the following cardiac issues:

• Portopulmonary hypertension: Defined as a mean pulmonary arterial pressure >25 mmHg and pulmonary capillary wedge pressure <15 mmHg, often presenting with dyspnea, fatigue, orthopnea, or chest pain. It is thought to be triggered by increased pulmonary blood flow secondary to portal hypertension, which leads to vascular injury and remodeling.
• Cirrhotic cardiomyopathy: A hemodynamic consequence of portal hypertension characterized by systolic and/or diastolic dysfunction, left ventricular hypertrophy, and electrophysiological disturbances. The underlying mechanism involves myocardial wall stiffness resulting from fibrosis and subendothelial edema.
• Cardiac repolarization abnormalities: Prolongation of the corrected QT (QTc) interval is the most common finding, with its prevalence increasing in parallel with the severity of cirrhosis. Up to 60% of patients with end-stage liver disease exhibit an abnormal QTc.

This descriptive cohort study aims to systematically assess these cardiac outcomes across different liver disease groups. Data collection involves comprehensive clinical histories, including age at onset, disease type semiology, and detailed physical examinations covering general, abdominal, cardiac, neurological, and chest assessments.

Inclusion Criteria:

• All patients below 18 years who diagnosed with chronic liver disease.

Exclusion Criteria:

• All patients known to have congenital heart disease or previous cardiac disease.

The study population will consist of pediatric patients (under 18 years of age) diagnosed with chronic liver disease who are attending the gastroenterology and hepatology unit at Assiut University Children's Hospital. The population will include patients with various underlying causes of chronic liver disease, such as autoimmune hepatitis, viral hepatitis (B and C), Wilson's disease, and cystic fibrosis. Patients with known congenital heart disease or a history of previous cardiac disease will be excluded from this population.