Abstract 17065: Utilization of Magnetic Resonance Lymphangiography to Determine the Etiology of Chylothorax and Predict the Outcome of Lymphatic Embolization in Patients With Congenital Heart Disease
Introduction: Postoperative chylothorax in patients with congenital heart disease (CHD) is a challenging problem with high morbidity and mortality. Dynamic contrast-enhanced MR lymphangiography (DCMRL) is a novel technique to visualize the lymphatic system.
Methods: This study is a retrospective review of 18 patients with CHD and postoperative chylothorax, who presented for lymphatic intervention at our institution between July 2012 and May 2016.
Results: All 18 patients had T2-weighted MR imaging and 17 patients had both DCMRL and intranodal lymphangiography performed prior to intervention. We identified three groups: 2 patients (11%) with traumatic leak from a branch of the thoracic duct (TD), 9 patients (50%) with abnormal pulmonary lymphatic flow, and 7 patients (39%) with a central lymphatic flow disorder (CLFD). We define CLFD as lymphatic effusions in multiple compartments and retrograde central lymphatic flow by imaging. The patients with traumatic leak and abnormal pulmonary lymphatic flow were combined into a group of 11 patients without CLFD, of which 10 (91%) had an intact central TD. All 11 patients underwent lymphatic intervention, including selective or complete TD embolization. The median chest tube drainage decreased significantly from 7 days before (21 ml/kg/day, IQR 15-34) to 7 days after intervention (14 ml/kg/day, IQR 5-22) (p = 0.021). All 11 patients had resolution of chylothorax, with a median of 18 days (IQR 6-47) from intervention to discharge. Of the 7 patients with CLFD, 4 (57%) had an intact TD and 7 (100%) had ascites. Six patients underwent lymphatic intervention and there was no difference in the median chest tube drainage from 7 days before (31 ml/kg/day, IQR 27-61) to 7 days after intervention (38 ml/kg/day, IQR 16-111) (p = 0.735). All 7 patients died, with a median of 79 days (IQR 33-187) from intervention to death.
Conclusions: The majority of patients in this study had non-traumatic chylothorax and DCMRL was essential to determine the etiology. Percutaneous lymphatic embolization was successful in patients with traumatic leak and abnormal pulmonary lymphatic flow, and thus should be considered as first-line treatment. Interventions in patients with CLFD were not successful and alternate approaches need to be developed.
- Congenital heart disease
- Lymphatic disease
- Magnetic resonance imaging
- Percutaneous non-coronary cardiac intervention
- Pediatric cardiology
Author Disclosures: J. Savla: None. M. Itkin: None. J.W. Rossano: None. Y. Dori: None.
- © 2016 by American Heart Association, Inc.