Morphology and Function of the Lymphatic Vasculature in Patients With a Fontan Circulation
Research output: Contribution to journal › Journal article › Research › peer-review
BACKGROUND: The Fontan procedure has revolutionized the treatment of univentricular hearts. However, it is associated with severe complications such as protein-losing enteropathy, plastic bronchitis, and peripheral edema that may involve the lymphatic circulation. We aimed to assess lymphatic function and morphology in patients with a univentricular circulation.
METHODS: The functional state of lymphatic vessels in the lower extremities of patients with a Fontan circulation (n=10) was investigated using the novel technique near-infrared fluorescence imaging and compared with an age-, sex-, and weight-matched control group of healthy volunteers (n=10). The lymphatic morphology was described using T2-weighted magnetic resonance imaging, and microvascular permeability was estimated by strain gauge plethysmography.
RESULTS: The Fontan patients had 17% lower lymphatic pumping pressure (50±3.1 mm Hg) compared with controls (60±2.8 mm Hg; P=0.0341) and a 62% higher contraction frequency (0.8±0.1 min-1) compared with the healthy controls (0.5±0.1 min-1; P=0.0432). Velocity by which the lymph is moved and refill time after manual emptying of the lymphatic vessels showed no differences between the 2 groups. The thoracic duct was elongated 10% ( P=0.0409) and with an abnormal course in the Fontan patients compared with normal. No difference in microvascular permeability was found between the 2 groups.
CONCLUSIONS: Patients with a Fontan circulation have an impaired lymphatic pumping capacity and morphologically changed thoracic duct. Our results indicate a challenged lymphatic vasculature in the Fontan circulation and may play a role in the pathogenesis of the complications that are seen in Fontan patients.
CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03379805.
Original language | English |
---|---|
Article number | e008074 |
Journal | Circulation. Cardiovascular Imaging |
Volume | 12 |
Issue number | 4 |
Number of pages | 15 |
ISSN | 1941-9651 |
DOIs | |
Publication status | Published - Apr 2019 |
- Adolescent, Adult, Case-Control Studies, Diffusion Magnetic Resonance Imaging, Female, Fontan Procedure/adverse effects, Heart Defects, Congenital/diagnostic imaging, Humans, Lower Extremity, Lymphatic Diseases/diagnostic imaging, Lymphatic Vessels/diagnostic imaging, Male, Optical Imaging, Permeability, Plethysmography, Pressure, Thoracic Duct/diagnostic imaging, Treatment Outcome, Young Adult
Research areas
ID: 246198770