Lymph Drainage in Patients with Congestive Heart Failure

Dumont, Allan E.; Clauss, Roy H.; Reed, George E.; Tice, David A.

doi:10.1056/nejm196310312691804

Cited by 99 publications

(36 citation statements)

References 12 publications

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“…The maximal active tension produced by LSMCs and the equivalent transmural pressure describe the muscular limit for contractions and the maximal limit for pressure that the vessel can pump against, respectively. Our calculated value of ϳ21 mmHg parallels well with in vivo recordings of healthy human thoracic duct pressures around 20 mmHg (5,6,26,30,44). In the current study, the total tension generated after maximally activating human thoracic duct rings with NE-KPSS would produce an equivalent transmural pressure as high as 68 Ϯ 5.3 mmHg.…”

Section: Discussionsupporting

confidence: 83%

Human thoracic duct in vitro: diameter-tension properties, spontaneous and evoked contractile activity

Telinius

Drewsen

Pilegaard

et al. 2010

American Journal of Physiology-Heart and Circulatory Physiology

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The current study characterizes the mechanical properties of the human thoracic duct and demonstrates a role for adrenoceptors, thromboxane, and endothelin receptors in human lymph vessel function. With ethical permission and informed consent, portions of the thoracic duct (2-5 cm) were resected and retrieved at T7-T9 during esophageal and cardia cancer surgery. Ring segments (2 mm long) were mounted in a myograph for isometric tension (N/m) measurement. The diameter-tension relationship was established using ducts from 10 individuals. Peak active tension of 6.24 Ϯ 0.75 N/m was observed with a corresponding passive tension of 3.11 Ϯ 0.67 N/m and average internal diameter of 2.21 mm. The equivalent active and passive transmural pressures by LaPlace's law were 47.3 Ϯ 4.7 and 20.6 Ϯ 3.2 mmHg, respectively. Subsequently, pharmacology was performed on rings from 15 ducts that were normalized by stretching them until an equivalent pressure of 21 mmHg was calculable from the wall tension. At low concentrations, norepinephrine, endothelin-1, and the thromboxane-A2 analog U-46619 evoked phasic contractions (analogous to lymphatic pumping), whereas at higher contractions they induced tonic activity (maximum tension values of 4.46 Ϯ 0.63, 5.90 Ϯ 1.4, and 6.78 Ϯ 1.4 N/m, respectively). Spontaneous activity was observed in 44% of ducts while 51% of all the segments produced phasic contractions after agonist application. Acetylcholine and bradykinin relaxed norepinephrine preconstrictions by ϳ20% and ϳ40%, respectively. These results demonstrate that the human thoracic duct can develop wall tensions that permit contractility to be maintained across a wide range of transmural pressures and that isolated ducts contract in response to important vasoactive agents. lymphatic system; lymph pump; lymphangion; lymphatic smooth muscle THE EXCESS FLUID AND PROTEIN of the interstitial spaces in almost all tissues of the body are collected and removed by the lymphatic system. The lymphatic capillaries converge into larger collecting lymphatics, and, ultimately, these terminate into large transport vessels, which return lymph to the blood circulation. The lymphatic system lacks a central pump to drive the transport of lymph. Instead, it is generally accepted that the lymphatic smooth muscle cells (LSMCs) in the collecting and transporting lymphatic vessel wall are responsible for propelling lymph forward by intrinsic contractions. The lymphatic vessels responsible for pumping are comprised of multiple contractile segments separated by unidirectional valves to prevent backflow, termed a lymphangion, and each lymphangion performs much like a cardiac ventricle to provide unidirectional pumping. The contractile part of the lymphatic vasculature can thus be likened to a system of ventricles in series (27). The thoracic duct is the largest lymphatic vessel in the human body. Under normal conditions (i.e., in healthy individuals), it is a low-flow system that drains up to 1 ml/min to the venous circulation (30,44). The volume and flow of lymph a...

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Section: Discussionsupporting

confidence: 83%

Human thoracic duct in vitro: diameter-tension properties, spontaneous and evoked contractile activity

Telinius

Drewsen

Pilegaard

et al. 2010

American Journal of Physiology-Heart and Circulatory Physiology

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“…High venous pressure increases the abdominal lymph production secondary to an augmented capillary filtration. The lymph flow of the thoracic duct can increase by up to 12 fold the normal rate, but the stiffness of the venolymphatic junction in the neck limits lymphatic flow [8].…”

Section: Discussionmentioning

confidence: 99%

Chylothorax and chylous ascites due to heart failure

Villena

Pablo²,

Martı́n-Escribano³

1995

Eur Respir J

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“…Chylous ascites in the present case may have been pro-duced by two possible mechanisms: 1) high pressure in the left subclavian vein may reduce lymphatic drainage; (3) 2) the lymph flow of the thoracic duct can increase, but the stiffness of the venolymphatic junction in the neck can limit lymphatic flow (10). The mechanism of chylothorax in this patient has not been explained, but high left subclavian venous pressure may have been a contributory factor.…”

Section: F I G U R E 2 a He Ma T O X Y L I N A N D E O S I N S T Amentioning

confidence: 67%

Chylous Ascites and Chylothorax: An Unusual Manifestation of Cardiac Amyloidosis

Chen

Hsu

et al. 2010

Intern. Med.

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Lymph Drainage in Patients with Congestive Heart Failure

Cited by 99 publications

References 12 publications

Human thoracic duct in vitro: diameter-tension properties, spontaneous and evoked contractile activity

Human thoracic duct in vitro: diameter-tension properties, spontaneous and evoked contractile activity

Chylothorax and chylous ascites due to heart failure

Chylous Ascites and Chylothorax: An Unusual Manifestation of Cardiac Amyloidosis

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