Decompression of the thoracic duct: A novel transcatheter approach

Citations Over TimeTop 10% of 2019 papers

Abstract

In patients with total cavopulmonary connections, elevated central venous pressures (CVP) have detrimental effects on the lymphatic system causing an imbalance in fluid production and drainage of the interstitium. This combination may result in life-threatening lymphatic complications including plastic bronchitis (PB), protein losing enteropathy (PLE), chylothorax, and ascites. While embolization of the abnormal lymphatics has greatly improved outcomes from these complications, alternative treatment strategies have been proposed that would result in improved lymphatic drainage while leaving the lymphatic system intact. We report two novel transcatheter approaches for thoracic duct (TD) decompression in two patients who developed PLE after completion of the Fontan procedure as part of staged palliation for congenital heart disease. In addition, one patient had severe concurrent PB. In both patients, a connection was created between a left superior vena cava (LSVC) to the left atrium allowing for a nonsurgical method to decompress the TD. This procedure resulted in significant clinical and laboratory improvement of both patients' PLE and other symptoms of lymphatic dysfunction.

Related Papers

• → Endolymphatic Interventions for the Treatment of Chylothorax and Chylous Ascites in Neonates: Technical and Clinical Success and Complications(2018)20 cited
• → Chylous Ascites: A Rare Complication of Thoracic Duct Embolization for Chylothorax(2010)30 cited
• → Use of lymphangiography in neonates prior to thoracic duct ligation(2020)2 cited
• → CONGENITAL DEFECTS OF THE LYMPHATICS IN INFANCY(1957)71 cited
• → Treatment Strategy on Chylolymphatic/Lymphatic Reflux(2017)1 cited