The temporal sequence of lymph flow in the right lymphatic duct in experimental chronic pulmonary edema

Uhley, Herman N.; Leeds, Sanford E.; Sampson, John J.; Rudo, N.; Friedman, Meyer

doi:10.1016/0002-8703(66)90445-5

Cited by 9 publications

(4 citation statements)

References 5 publications

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“…The thoracic duct lymph flow is significantly increased under such conditions, as demonstrated in the experimental right ( 127 ) and left ( 128 ) HF and in patients with HF ( 129 , 130 ). This is also well-documented in the lung, where the lymphatic vasculature markedly increases its drainage capacity in response to chronic elevation of left atrial (LA) pressure ( 131 , 132 ). This functional expansion of the pulmonary lymphatic system has also been demonstrated in patients with mitral stenosis, where dilated lymphatics in the pleura and interlobular septa were observed, and in some cases, the lymphatics had acquired a hypertrophied muscular wall ( 133 ).…”

Section: The Lymphatic Systemmentioning

confidence: 88%

The interstitial compartment as a therapeutic target in heart failure

Aronson

2022

Front. Cardiovasc. Med.

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Congestion is the single most important contributor to heart failure (HF) decompensation. Most of the excess volume in patients with HF resides in the interstitial compartment. Inadequate decongestion implies persistent interstitial congestion and is associated with worse outcomes. Therefore, effective interstitial decongestion represents an unmet need to improve quality of life and reduce clinical events. The key processes that underlie incomplete interstitial decongestion are often ignored. In this review, we provide a summary of the pathophysiology of the interstitial compartment in HF and the factors governing the movement of fluids between the interstitial and vascular compartments. Disruption of the extracellular matrix compaction occurs with edema, such that the interstitium becomes highly compliant, and large changes in volume marginally increase interstitial pressure and allow progressive capillary filtration into the interstitium. Augmentation of lymph flow is required to prevent interstitial edema, and the lymphatic system can increase fluid removal by at least 10-fold. In HF, lymphatic remodeling can become insufficient or maladaptive such that the capacity of the lymphatic system to remove fluid from the interstitium is exceeded. Increased central venous pressure at the site of the thoracic duct outlet also impairs lymphatic drainage. Owing to the kinetics of extracellular fluid, microvascular absorption tends to be transient (as determined by the revised Starling equation). Therefore, effective interstitial decongestion with adequate transcapillary plasma refill requires a substantial reduction in plasma volume and capillary pressure that are prolonged and sustained, which is not always achieved in clinical practice. The critical importance of the interstitium in the congestive state underscores the need to directly decongest the interstitial compartment without relying on the lowering of intracapillary pressure with diuretics. This unmet need may be addressed by novel device therapies in the near future.

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Section: The Lymphatic Systemmentioning

confidence: 88%

The interstitial compartment as a therapeutic target in heart failure

Aronson

2022

Front. Cardiovasc. Med.

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“…It has been shown that our method of producing congestive failure (aorticocaval fistula, desoxycorticosterone trimethylacetate and a salt enriched diet) can lead to cardiomegaly and overt pulmonary edema after 21 days (3). At the earlier stage used in these experiments, i.e.…”

Section: Discussionmentioning

confidence: 97%

Right Duct Lymph Flow in Experimental Heart Failure Following Acute Elevation of Left Atrial Pressure

Uhley¹,

Leeds²,

Sampson³

et al. 1967

Circulation Research

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We measured the pulmonary lymph flow in dogs with mild congestive failure before and after acute elevation of the left atrial pressure to 40 cm of water. The creation of an aorticocaval fistula and the administration of desoxycorticosterone trimethylacetate and a salt enriched diet in 6 dogs produced mild pulmonary edema and partial expansion of the pulmonary lymphatics 10 to 12 days postoperatively. Elevation of the left atrial pressure to 40 cm of water under pentobarbital anesthesia led to an immediate increase in right duct flow in the "mild failure" dogs, in contrast to a delayed flow in normal dogs. The average peak flows in the 10-to 12-day dogs after increasing the left atrial pressure were higher than the peak flows observed in normal dogs. In addition, the mild failure dogs survived twice as long as normal dogs after acute elevation of the left atrial pressure. These results suggest that an animal with an expanded pulmonary lymph system is better able to withstand the stress of acute elevation of left atrial pressure than a normal animal. The pulmonary lymph system may serve as an important compensatory mechanism in the prevention of fulminating pulmonary edema. ADDITIONAL KEY WORDS lymphatic system (pulmonary) arteriovenous anastomosisedema desoxycorticosterone arteriovenous fistula lymph (pulmonary) pulmonary circulation pulmonary edema anesthetized dogs• Following the production of chronic pulmonary edema in dogs by our technique (1), the right duct lymphatics that drain the lung became markedly enlarged and a very large increase in right duct lymph flow occurred.Since only a limited augmentation in lymph flow occurred in acute pulmonary edema produced by elevating left atrial pressure to 40 cm of water (2), we suspected that a gradually developing expansion of the lymph system may play a role as a compensatory mechanism in chronic pulmonary edema, by From the facilitating the removal of critical accumulations of fluid from the lungs. The present experiment was designed to study pulmonary lymph flow and the course of events subsequent to acute elevation of the left atrial pressure in dogs with mild chronic pulmonary edema, whose lymphatics, presumably, have had a chance to partially expand, and in normal dogs subjected to the same acute elevation of left atrial pressure. It has been demonstrated that 10 days after initiation of procedures inducing chronic heart failure in the dog (3), right duct lymph flow began to increase significantly and presumably lymphatic expansion was well underway. Accordingly, the right duct lymph flow was recorded (4) before and after elevation of left atrial pressure at 40 cm of water by inflating a balloon (2) in the left atrium of 306

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“…Ces découvertes ont été confirmées en 1939 par les recherches de Paul R. Patek (university of California, Los Angeles, UCLA, États-Unis) qui met en évidence, chez le chien, le drainage lymphatique cardiaque grâce à l'injection dans le myocarde d'encre de Chine. À partir des années 1960, plusieurs études sont réalisées chez de gros animaux, démontrant que le réseau lymphatique cardiaque est essentiel pour l'homéostasie fluidique du coeur et que l'oedème cardiaque, lié à une évacuation lymphatique insuffisante, conduit à la dysfonction cardiaque [26,27].…”

Section: Origine Embryonnaire Du Système Lymphatiqueunclassified

Le système lymphatique cardiaque

Garmy‐Susini¹,

Pizzinat²,

Villeneuve³

et al. 2017

Med Sci (Paris)

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> Le système lymphatique est un réseau vasculaire responsable du transport des graisses intestinales. Il participe à la surveillance immune et permet le maintien de l'homéostasie tissulaire. Malgré un grand nombre d'évidences montrant l'importance des vaisseaux lymphatiques dans les maladies cardiovasculaires, le rôle des vaisseaux lymphatiques cardiaques n'a été que très peu étudié. En condition physiologique, le système lymphatique cardiaque régule dynamiquement le drainage des fluides interstitiels vers les ganglions médiastinaux afin de maintenir l'homéostasie du tissu cardiaque et de prévenir la formation d'un oedème. Après un infarctus du myocarde, les vaisseaux lymphatiques du coeur ischémique perdent leur fonction et contribuent au développement d'un oedème myocardique chronique qui aggrave la fibrose et la dysfonction cardiaque. La stimulation de la lymphangiogenèse cardiaque, fondée sur la délivrance de facteurs de croissance lymphangiogéniques comme le VEGF-C, pourrait représenter une nouvelle stratégie thérapeutique pour améliorer la fonction cardiaque. Cette revue met en évidence la chronologie des principales découvertes associées au développement et à la fonction lymphatique cardiaque. < captés par des cellules présentatrices d'antigènes (CPA) afin d'initier des réponses immunitaires spécifiques contre des particules qui pourraient être pathogènes (Figure 1) [3]. Les capillaires lymphatiques sont présents dans la peau et dans la plupart des organes internes, à l'exception de la moelle osseuse et des tissus avasculaires comme le cartilage, la cornée et l'épiderme. Dans l'intestin, les vaisseaux lymphatiques ont été initialement nommés « veines blanches » en raison de leur coloration blanche observée en phase postprandiale dans la région mésentérique. Ils jouent un rôle primordial dans l'absorption des lipides intestinaux ; ils sont encore appelés « lactés » ou « lactéaux », en raison de cette particularité [4]. Majoritairement présents dans les villosités de l'intestin grêle, les vaisseaux lymphatiques sont à l'origine de l'absorption des lipides alimentaires, libérés sous la forme de chylomicrons par les entéro-cytes (Figure 1). Les vaisseaux lymphatiques jouent également un rôle important dans le transport réverse du cholestérol [5,6]. La composition protéique de la lymphe est équivalente à celle du fluide interstitiel qui est similaire, mais généralement moins concentrée, à celle du plasma sanguin, à l'exception de la lymphe intestinale qui contient une grande quantité de lipides intestinaux [7]. Cette lymphe est une émulsion trouble et laiteuse, souvent appelée « chyle ». Le drainage lymphatique peut être considérablement modifié à la suite d'une infection, d'un traumatisme, d'une chirurgie, d'une transplantation, d'un traitement, ou d'une maladie veineuse ou congénitale [8,9]. La lymphangiogenèse, processus dirigeant la croissance de nouveaux vaisseaux lymphatiques, apparaît au cours du développement embryonnaire. Elle se met en place à partir de bourgeonnements du système sanguin [1]. Elle es...

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The temporal sequence of lymph flow in the right lymphatic duct in experimental chronic pulmonary edema

Cited by 9 publications

References 5 publications

The interstitial compartment as a therapeutic target in heart failure

The interstitial compartment as a therapeutic target in heart failure

Right Duct Lymph Flow in Experimental Heart Failure Following Acute Elevation of Left Atrial Pressure

Le système lymphatique cardiaque

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