Abstract 15623: Non-Invasive, Bedside Imaging of Lymphatics in an Infant With Chylothorax After Congenital Heart Surgery
Introduction: Chylothorax is a rare, but serious complication after congenital heart surgery in neonates. Management of this condition has been hampered by poor understanding of pathophysiology and limited therapeutic options. Lymphatic imaging could help to diagnose and guide therapy.
Methods: A five week old infant developed chylothorax after Norwood operation for Hypoplastic left heart syndrome. Initially, chyloascites and bilateral chylothoraces occurred. Medical management with inotropes, supportive therapy and Octreotide infusions failed. Non-invasive near-infrared fluorescence lymphatic imaging (NIRFLI) at the bedside was used to determine whether thoracic duct ligation or pleurodesis would restore normal drainage. After an emergency IRB and FDA approvals, indocyanine green was injected intradermally (0.025 - 0.05 ml of 0.25 mg/ml solution) in the left and right feet as well as left hand.
Result: NIRFLI showed that lymph flow from the feet stopped at the level of both groins. From left hand injection, lymph did not flow into the left subclavian vein, but instead, flowed into the left pleural space (Figure). Inference was that lymph flow into the thoracic duct was prevented due to high central venous pressure or obstruction.
Based on this inference, left pleurodesis was performed. Chyloascites reappeared after left pleurodesis and there was further deterioration of clinical status. “Comfort care” was instituted and the patient died.
Conclusion: This study showed the potential of non-invasive NIRFLI to understand the pathophysiology of lymph drainage in a vulnerable pediatric population after heart surgery. (Supported in parts by NIH R01 HL092923 and U54 CA136404)
- © 2013 by American Heart Association, Inc.