Functional lymphatic reserve capacity is depressed in patients with a Fontan circulation

Mohanakumar, Sheyanth; Kelly, Benjamin; Turquetto, Aida Luiza Ribeiro; Alstrup, Mathias; Amato, Luciana Patrick; Barnabe, Milena Schiezari Ru; Silveira, João Bruno Dias; Amaral, Fernando Colbari do; Manso, Paulo Henrique; Jatene, Marcelo Biscegli; Hjortdal, Vibeke E.

doi:10.14814/phy2.14862

Cited by 12 publications

(11 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4,14 The evidence describing functional changes in the lymphatic system in Fontan patients remains scarce. 16,27 Mohanakumar et al reported 17% lower occlusion pressure of the lower extremity collecting lymphatic vessels compared to age, gender, and weight-matched controls but was unable to confirm findings in a larger population. 16,27 In a rare study connecting lymphatic complications with morphological findings, Dori et al showed increased TD diameters in patients with PLE and PB compared to Fontan patients without complications.…”

Section: Discussionmentioning

confidence: 92%

“…16,27 Mohanakumar et al reported 17% lower occlusion pressure of the lower extremity collecting lymphatic vessels compared to age, gender, and weight-matched controls but was unable to confirm findings in a larger population. 16,27 In a rare study connecting lymphatic complications with morphological findings, Dori et al showed increased TD diameters in patients with PLE and PB compared to Fontan patients without complications. 19 While not proving causality, the findings of an inverse correlation between TD diameter and the ability of the TD to contract and increase pressure during manual occlusion goes some way in increasing knowledge of the challenges of Fontan individuals with lymphatic failure.…”

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

Occlusion Pressure of the Thoracic Duct in Fontan Patients With Lymphatic Failure: Does Dilatation Challenge Contractility?

Savla

Kelly

Krogh

et al. 2022

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Background The Fontan circulation challenges the lymphatic system. Increasing production of lymphatic fluid and impeding lymphatic return, increased venous pressure may cause lymphatic dilatation and decrease lymphatic contractility. In-vitro studies have reported a lymphatic diameter-tension curve, with increasing passive stretch affecting the intrinsic contractile properties of each thoracic duct segment. We aimed to describe thoracic duct occlusion pressure and asses if thoracic duct dilation impairs contractility in individuals with a Fontan circulation and lymphatic failure. Methods Central venous pressure and thoracic duct measurements were retrospectively collected from 31 individuals with a Fontan circulation. Thoracic duct occlusion pressure was assessed during a period of external manual compression and used as an indicator of lymphatic vessel contractility. Measurements of pressure were correlated with measurements of the thoracic duct diameter in images obtained by dynamic contrast-enhanced MR lymphangiography. Results The average central venous pressure and average pressure of the thoracic duct were 17 mm Hg. During manual occlusion, the thoracic duct pressure significantly increased to 32 mm Hg. The average thoracic duct diameter was 3.3 mm. Thoracic duct diameter correlated closely with the central venous pressure. The rise in pressure following manual occlusion showed an inverse correlation with the diameter of the thoracic duct. Conclusion Higher central venous pressures are associated with increasing diameters of the thoracic duct. When challenged by manual occlusion, dilated thoracic ducts display a decreased ability to increase pressure. Dilatation and a resulting decreased contractility may partly explain the challenged lymphatic system in individuals with a Fontan circulation.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Occlusion Pressure of the Thoracic Duct in Fontan Patients With Lymphatic Failure: Does Dilatation Challenge Contractility?

Savla

Kelly

Krogh

et al. 2022

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

show abstract

“…Hyperthermia leads to the increased interstitial fluid formation and has been used to evaluate lymphatic function. Kelly et al (2019) and Mohanakumar et al (2021) used NIRF imaging to investigate the effects of hyperthermia on the peripheral lymphatic vessels. Furthermore, Olszewski et al (1977) investigated the effects of hyperthermia using lymphatic cannulation.…”

Section: Discussionmentioning

confidence: 99%

Gravity and lymphodynamics

Holm-Weber

Kristensen

Mohanakumar

et al. 2022

Physiological Reports

Self Cite

View full text Add to dashboard Cite

The lymphatic system is compromised in different groups of patients. To recognize pathology, we must know what is healthy. We use Near‐Infrared Fluorescence (NIRF) to assess peripheral lymphatic function in humans. We have shown that external factors such as exercise, hyperthermia, and pharmacological mediators influence the function of peripheral lymphatic vessels. In this study, we explored the impact on lymphatic vessels by the ever‐present external factor—gravity. We used NIRF imaging to investigate the lymphatic changes to gravity. Gravity was assessed by changing body position from supine to standing. We extracted following lymphatic functional parameters: lymphatic packet propulsion frequency (contractions/min), velocity (cm/s), and pressure (mmHg). Raw data analysis was performed using a custom‐written Labview program. All sequences were analyzed by two observers and interclass correlation scores were calculated. All statistical analysis was performed using RStudio Team (2021). RStudio: Integrated Development Environment for R. RStudio, PBC. Healthy participants (n = 17, 11 males, age 28.1 ± 2.6 years) were included. The lymphatic packet propulsion frequency at baseline was 0.5 ± 0.2 contractions/min and rose within 3 min significantly to a maximum of 1.2 ± 0.5 contractions/min during upright posture and remained significantly higher than the baseline lymphatic packet propulsion frequency after lying down again for up to 6 min. The lymph velocity was 1.5 ± 0.4 cm/s at baseline and changed in both directions and without a specific pattern at different points in time during standing. Lymph pressure was significantly higher while standing (mean increase 9 mmHg, CI: 2–15 mmHg). The ICC scores were 89.8% (85.9%–92.7%), 59.3% (46.6%–69.6%) and 89.4% (79.0%–94.8%) in lymphatic packet propulsion frequency (130 observations), velocity (125 observations), and pressure (30 observations), respectively. The lymphatic system responds within few minutes to gravitational changes by increasing lymphatic packet propulsion frequency and pressure.

show abstract

“…Like in the primary study as well as several others, especially in patients with lymphatic complications, we observed a higher lymphatic propulsion velocity in the ipsilateral arm compared contralaterally ( P = 0.01). 15 , 28 , 29 This may be caused by the lymphatic vessels being slightly more contracted and with reduced compliance due to collagen deposition, so that if the lymphatic vessel diameter decreases, the velocity of the fluid increases during a constant flow.…”

Section: Discussionmentioning

confidence: 99%

“…8,9,18 In line with above-mentioned theories, it was highly interesting that BCRL patients and patients with lymphatic morphological abnormalities were not able to increase CF significantly (Table 1), whereas their own contralateral arms as well as remaining subgroups demonstrated expected increases in CF. Mohanakumar et al 28 found that Fontan patients, a particular group of patients with congenital heart disease prone to lymphatic complications, have similar difficulties in increasing CF after inducing hyperthermia.…”

Section: Decreased Ability To Mobilize Reserve Capacity Of Lymphatic ...mentioning

confidence: 99%

Lymphatic Function Decreases over Time in the Arms of Breast Cancer Patients following Treatment

Johannessen

Alstrup

Hjortdal

et al. 2022

Plastic and Reconstructive Surgery - Global Open

Self Cite

View full text Add to dashboard Cite

Background: In patients with breast cancer-related lymphedema, distinct lymphatic patterns and changed lymphatic contractile function have been described, but it is unknown how these characteristics change over time and to what extent they appear before clinical edema is detectable. Recently, we described the lymphatic morphology and function in a cohort of breast cancer patients shortly after radiation therapy (RT). In the current study, we investigate lymphatic function and morphology in the same cohort after 1 year of follow-up. Methods: The study population consisted of 28 breast cancer patients investigated 12 months after adjuvant locoregional RT. Lymphatic contraction frequency (CF), propulsion velocity, and the morphology of lymphatic vessels in the upper extremities were described in vivo using near-infrared fluorescence imaging. Lymphatic stress test was performed using hyperthermia. Results: At 1 year after RT, (n = 28) 46% of the patients presented with lymphatic morphological abnormalities with a degree of dermal backflow and 21% had developed clinical breast cancer-related lymphedema. In the ipsilateral arm, CF was 23% lower than in the contralateral arm (P = 0.04). Since primary examination, CF in the ipsilateral arm decreased by 40% (P = 0.03), whereas no change was observed in the contralateral arm. During hyperthermia, the ipsilateral arms with lymphatic complications were not able to increase CF as the remaining subgroups. Conclusions: Lymphatic function in the ipsilateral arm deteriorated over time after adjuvant breast cancer therapy. Furthermore, the presence of abnormal torturous lymphatic vessels in asymptomatic arms appeared to be associated with weak lymphatic reserve pumping capacity.

show abstract

Functional lymphatic reserve capacity is depressed in patients with a Fontan circulation

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 12 publications

References 42 publications

Occlusion Pressure of the Thoracic Duct in Fontan Patients With Lymphatic Failure: Does Dilatation Challenge Contractility?

Occlusion Pressure of the Thoracic Duct in Fontan Patients With Lymphatic Failure: Does Dilatation Challenge Contractility?

Gravity and lymphodynamics

Lymphatic Function Decreases over Time in the Arms of Breast Cancer Patients following Treatment

Contact Info

Product

Resources

About