Abstract
Background. Compromised lymphatic drainage in patients with Fontan circulation considered as an important factor in the development of such formidable complications as plastic bronchitis and protein-loss enteropathy. Purpose of the study: to determine the potential of non-contrast magnetic resonance lymphography (MRL) in assessing the anatomy and pathology of central lymphatic system in patients with complex coronary heart diseases with Fontan circulation.
Materials and methods. In 2022, 40 patients (22 where girls and 18 boys) after the previously performed Fontan completion underwent non-contrast MRL of the central lymphatic system. The age of the patients ranged from 4 to 34 (15.3 ± 9.8) years.
Results. The thoracic duct was visualized in 33 (83%) patients. At the same time, it was possible to assess its transverse size and location relative to the backbone and. Thoracic duct tortuosity index (TI) was used for quantitative assessment of its deformation, which averaged 1.11 ± 0.09. Statistical analysis revealed a significant negative correlation between TI and flow velocity in the superior vena cava and single ventricle ejection fraction. When analyzing the degree of impaired perfusion of lymphatic fluid in the soft tissues and mediastinum, patients with types 1 and 2 of impaired lymph perfusion prevailed (38% and 45%, respectively). When assessing impaired lymph perfusion at the level of the retroperitoneal space, 35% of patients showed a diffuse increase in MR-signal.
Conclusion. Magnetic resonance lymphography allows assessing the state of the central lymphatic system and identifying early signs of impaired lymphatic fluid outflow, which, with the accumulation and analysis of the data obtained, may be predictors of such complications as plastic bronchitis and protein-deficient enteropathy.
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About the authors
- Tatyana V. Mataeva, Cand. Med. Sci., Radiologist; ORCID
- Svetlana A. Aleksandrova, Cand. Med. Sci., Head of the Department; ORCID
- Dmitriy V. Kovalev, Dr. Med. Sci., Researcher; ORCID
- Viktor S. Mataev, Cand. Med. Sci., Cardiac Surgeon; ORCID
- Aleksey V. Dorofeev, Cand. Med. Sci., Head of Department; ORCID
- Irakliy P. Aslanidi, Dr. Med. Sci., Professor, Head of Department; ORCID
- Vladimir P. Podzolkov, Dr. Med. Sci., Professor, Academician of RAS, Head of Department; ORCID
