Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Department of Pediatric Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Eur J Cardiothorac Surg. 2022 Sep 2;62(4). doi: 10.1093/ejcts/ezac103.
Complications after Fontan surgery have been associated with arise and classification of abnormal thoracic lymphatic perfusion pattern. This study compiles abnormal abdominal lymphatic perfusion patterns and investigates their impact on serum protein readings.
We performed a retrospective analysis of patients who underwent magnetic resonance imaging with T2-weighted lymphatic imaging and serum protein measurements 6 months after having Fontan surgery. The abdominal lymphatic images were classified according to the anatomical lymphatic drainage patterns into 2 categories: (1) para-aortic (types 1-4); (2) portal-venous (types 1-3). Thoracic lymphatic images were classified (types 1-4) as described earlier.
A total of 71 patients were included in the study. Para-aortic lymphatic perfusion patterns were classified as type 1 in 4, type 2 in 13, type 3 in 37 and type 4 in16 out of 71 patients. Portal-venous lymphatic perfusion patterns were classified as type 1 in 20, type 2 in 10 and type 3 in 41 patients. Thoracic lymphatic perfusion patterns were classified as type 1 in 8, type 2 in 11, type 3 in 39 and type 4 in 13 patients. The serum protein level was 66 (interquartile range: 7.5) g/l (< standard value in 37%). Higher-grade para-aortic (p = 0.0062), portal-venous (p = 0.022) and thoracic (p = 0.011) lymphatic abnormalities were correlated with lower total serum protein levels. Higher ratings of para-aortic lymphatic abnormalities were significantly associated with higher ratings of portal-venous abnormalities (p < 0.0001). Ratings of para-aortic and portal-venous classifications were correlated with the thoracic classification (p < 0.001).
Abnormal abdominal lymphatic perfusion patterns can be classified according to anatomical structures with increasing severity. Higher grade abdominal and thoracic lymphatic perfusion patterns are associated with lower serum protein values.
Fontan 手术后的并发症与异常胸淋巴灌注模式的出现和分类有关。本研究汇编了异常腹部淋巴灌注模式，并研究了其对血清蛋白读数的影响。
我们对接受磁共振成像（MRI）检查的患者进行了回顾性分析，这些患者在 Fontan 手术后 6 个月进行了 T2 加权淋巴成像和血清蛋白测量。根据解剖学淋巴引流模式，将腹部淋巴图像分为 2 类：（1）腹主动脉旁（类型 1-4）；（2）门静脉（类型 1-3）。如前所述，对胸淋巴图像进行分类（类型 1-4）。
本研究共纳入 71 例患者。4 例患者的腹主动脉旁淋巴灌注模式为 1 型，13 例为 2 型，37 例为 3 型，16 例为 4 型。门静脉旁淋巴灌注模式为 20 例 1 型，10 例 2 型，41 例 3 型。胸淋巴灌注模式为 8 例 1 型，11 例 2 型，39 例 3 型，13 例 4 型。血清蛋白水平为 66（四分位距：7.5）g/L（37%低于标准值）。较高等级的腹主动脉旁（p = 0.0062）、门静脉（p = 0.022）和胸（p = 0.011）淋巴异常与总血清蛋白水平较低相关。较高等级的腹主动脉旁淋巴异常与较高等级的门静脉异常显著相关（p < 0.0001）。腹主动脉旁和门静脉分类评分与胸分类评分相关（p < 0.001）。
异常腹部淋巴灌注模式可根据解剖结构进行分类，严重程度递增。较高等级的腹部和胸淋巴灌注模式与较低的血清蛋白值相关。
