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CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2021; 69(S 03): e1-e9
DOI: 10.1055/s-0040-1722178
Pediatric and Congenital Cardiology

Association of Lymphatic Abnormalities with Early Complications after Fontan Operation

Sven Dittrich 
1   Department of Pediatric Cardiology, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
,
Anja Weise
1   Department of Pediatric Cardiology, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
,
Robert Cesnjevar
2   Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Erlangen, Bavaria, Germany
,
Oliver Rompel
3   Radiology Institute, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
,
André Rüffer
4   Department of Pediatric Cardiac Surgery, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
,
Martin Schöber
1   Department of Pediatric Cardiology, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
,
Julia Moosmann 
1   Department of Pediatric Cardiology, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
,
Martin Glöckler
1   Department of Pediatric Cardiology, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
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Abstract

Background Increased central venous pressure is inherent in Fontan circulation but not strongly related to Fontan complication. Abnormalities of the lymphatic circulation may play a crucial role in early Fontan complications.

Methods This was a retrospective, single-center study of patients undergoing Fontan operation from 2008 to 2015. The primary outcome was significant early Fontan complication defined as secondary in-hospital treatment due to peripheral edema, ascites, pleural effusions, protein-losing enteropathy, or plastic bronchitis. All patients received T2-weighted magnetic resonance images to assess abdominal and thoracic lymphatic perfusion pattern 6 months after Fontan completion with respect to localization, distribution, and extension of lymphatic perfusion pattern (type 1–4) and with application of an area score (0–12 points).

Results Nine out of 42 patients developed early Fontan complication. Patients with complication had longer chest tube drainage (mean 28 [interquartile range [IQR]: 13–60] vs. 13 [IQR: 2–22] days, p = 0.01) and more often obstructions in the Fontan circuit 6 months after surgery (56 vs. 15%, p = 0.02). Twelve patients showed little or no abnormalities of lymphatic perfusion (lymphatic perfusion pattern type 1). Most frequently magnetic resonance imaging showed lymphatic congestion in the supraclavicular region (24/42 patients). Paramesenteric lymphatic congestion was observed in eight patients. Patients with early Fontan complications presented with higher lymphatic area score (6 [min–max: 2–10] vs. 2 [min–max: 0–8]), p = 0.001) and greater distribution and extension of thoracic lymphatic congestion (type 3–4: n = 5/9 vs. n = 1/33, p = 0.001).

Conclusion Early Fontan complication is related to hemodynamic factors such as circuit obstruction and to the occurrence and extent of lymphatic congestion.

Keywords

congenital heart disease - Fontan operation - lymphatic perfusion pattern - cardiovascular magnetic resonance imaging


Publikationsverlauf

Eingereicht: 09. Juli 2020

Angenommen: 30. Oktober 2020

Artikel online veröffentlicht:
31. Dezember 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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