Transvenous retrograde thoracic duct embolization for effective treatment of recurrent plastic bronchitis after fontan palliation

Abstract

We report the case of a 5.5-year-old patient (16 kg/105 cm) who presented with plastic bronchitis (PB) refractory to conservative treatment 3 months after completion of Fontan palliation. Bi-inguinal transnodal fluoroscopy-guided lymphangiogram confirmed the chylous leak originating from the thoracic duct (TD) into the chest and did not opacify any central lymphatic vessel for direct transabdominal puncture. Retrograde transfemoral approach was adopted to catheterize the TD and selectively embolize its caudal portion using microcoils and liquid embolic adhesive.Recurrence of symptoms after 2 months indicated a redo catheterization to occlude the TD entirely using the same technique. The procedure was successful and the patient was discharged after 2 days with sustained clinical improvement at 24 months postoperative. In the context of refractory PB, end-to-end transvenous retrograde embolization of the TD appears to be an interesting alternative to more complex interventions such as transabdominal puncture, decompression, or surgical ligation of the TD.

Idiopathic Chylopericardium in a 7-Year-Old Female with Latent Tuberculosis: A Case Report and Literature Review

“…In the paediatric population, secondary chylopericardium can be caused by systemic infection, Volume 9; Issue 01 Cardiolog Res Cardiovasc Med, an open access journal ISSN: 2575-7083 malignancy including lymphoma, and most commonly trauma or surgery [16]. Idiopathic chylopericardium can rarely be caused by thoracic lymph vessel anomalies as is seen in our case [17,18].…”

“…Embolization involves deploying embolic material (typically n-BCA glue, coils, or both) directly into the thoracic duct (nonselective embolization) or into an abnormal lymphatic channel (selective embolization) [23]. One study demonstrated a 75% clinical success rate in managing nontraumatic chylous effusions, including nontraumatic chylopericardium, with clinical success being measured as no recurrence of effusion [17]. Embolization with access via catheterization was ultimately the most effective treatment for our patient, with resolution of pericardial effusion on postoperative imaging.…”

SwiftNINJA steerable microcatheter: a new kid on the block for selective catheterization of vascular and valvular congenital lesions

“…During interstage catheterization of patients with modified surgical Norwood procedures, SM would also fasten transarterial cannulation of banded pulmonary arteries that originate usually high and posteriorly within the pulmonary homograft ( 26 ). It could also be a game changer for transvenous retrograde thoracic duct cannulation and embolization in Fontan patients with recurrent plastic bronchitis ( 27 ). In addition, Soyama et al described a new technique of compact coil packing for the target vessels with the use of intentional folding by the bendable tip of the SM ( 8 ).…”