Functional lymphatic reserve capacity is depressed in patients with a Fontan circulation.

Autor: Mohanakumar S; Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.; Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.; Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark., Kelly B; Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Turquetto ALR; Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil., Alstrup M; Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Amato LP; Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil., Barnabe MSR; Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil., Silveira JBD; Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil., Amaral F; Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil.; Pediatric and Adult Congenital Heart Disease Unit, Hospital das Clínicas, Ribeirão Preto, Brazil., Manso PH; Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil.; Pediatric and Adult Congenital Heart Disease Unit, Hospital das Clínicas, Ribeirão Preto, Brazil., Jatene MB; Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil., Hjortdal VE; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.; Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: Physiological reports [Physiol Rep] 2021 Jun; Vol. 9 (11), pp. e14862.
DOI: 10.14814/phy2.14862
Abstrakt: Background: Lymphatic abnormalities play a role in effusions in individuals with a Fontan circulation. Recent results using near-infrared fluorescence imaging disclosed an increased contraction frequency of lymphatic vessels in Fontan patients compared to healthy controls. It is proposed that the elevated lymphatic pumping seen in the Fontan patients is necessary to maintain habitual interstitial fluid balance. Hyperthermia has previously been used as a tool for lymphatic stress test. By increasing fluid filtration in the capillary bed, the lymphatic workload and contraction frequency are increased accordingly. Using near-infrared fluorescence imaging, the lymphatic functional reserve capacity in Fontan patients were explored with a lymphatic stress test.
Methods: Fontan patients (n = 33) were compared to a group of 15 healthy individuals of equal age, weight, and gender. The function of the superficial lymphatic vessels in the lower leg during rest and after inducing hyperthermia was investigated, using near-infrared fluorescence imaging.
Results: Baseline values in the Fontan patients showed a 57% higher contraction frequency compared to the healthy controls (0.4 ± 0.3 min -1 vs. 0.3 ± 0.2 min -1 , p = 0.0445). After inducing stress on the lymphatic vessels with hyperthermia the ability to increase contraction frequency was decreased in the Fontan patients compared to the controls (0.6 ± 0.5 min -1 vs. 1.2 ± 0.8 min -1 , p = 0.0102).
Conclusions: Fontan patients had a higher lymphatic contraction frequency during normal circumstances. In the Fontan patients, the hyperthermia response is dampened indicating that the functional lymphatic reserve capacity is depressed. This diminished reserve capacity could be part of the explanation as to why some Fontan patients develop late-onset lymphatic complications.
(© 2021 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)
Databáze: MEDLINE
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