Castellanos Daniel A, Bucholz Emily M, Bai Katherine, Esch Jesse J, Hoganson David, Sanders Stephen P, Shaikh Raja, Ghelani Sunil J, Schidlow David N
Department of Cardiology, Boston Children's Hospital, Boston, MA, United States; Department of Pediatrics, Harvard Medical School, Boston, MA, United States.
Children's Hospital Colorado and the University of Colorado, Denver, CO, United States.
J Cardiovasc Magn Reson. 2024;26(2):101050. doi: 10.1016/j.jocmr.2024.101050. Epub 2024 Jun 21.
Disordered lymphatic drainage is common in congenital heart diseases (CHD), but thoracic duct (TD) drainage patterns in heterotaxy have not been described in detail. This study sought to describe terminal TD sidedness in heterotaxy and its associations with other anatomic variables.
This was a retrospective, single-center study of patients with heterotaxy who underwent cardiovascular magnetic resonance imaging at a single center between July 1, 2019 and May 15, 2023. Patients with (1) asplenia (right isomerism), (2) polysplenia (left isomerism) and (3) pulmonary/abdominal situs inversus (PASI) plus CHD were included. Terminal TD sidedness was described as left-sided, right-sided, or bilateral.
Of 115 eligible patients, the terminal TD was visualized in 56 (49 %). The terminal TD was left-sided in 25 patients, right-sided in 29, and bilateral in two. On univariate analysis, terminal TD sidedness was associated with atrial situs (p = 0.006), abdominal situs (p = 0.042), type of heterotaxy (p = 0.036), the presence of pulmonary obstruction (p = 0.041), superior vena cava sidedness (p = 0.005), and arch sidedness (p < 0.001). On multivariable analysis, only superior vena cava and aortic arch sidedness were independently associated with terminal TD sidedness.
Terminal TD sidedness is highly variable in patients with heterotaxy. Superior vena cava and arch sidedness are independently associated with terminal TD sidedness. Type of heterotaxy was not independently associated with terminal TD sidedness. This data improves the understanding of anatomic variation in patients with heterotaxy and may be useful for planning for lymphatic interventions.
先天性心脏病（CHD）中淋巴引流紊乱很常见，但内脏反位中胸导管（TD）引流模式尚未详细描述。本研究旨在描述内脏反位中TD末端的位置及其与其他解剖变量的关联。
这是一项回顾性单中心研究，研究对象为2019年7月1日至2023年5月15日在单中心接受心血管磁共振成像的内脏反位患者。纳入标准为：（1）无脾（右位异构），（2）多脾（左位异构），（3）肺/腹部脏器反位（PASI）加CHD。TD末端位置分为左侧、右侧或双侧。
115例符合条件的患者中，56例（49%）可见TD末端。25例患者TD末端位于左侧，29例位于右侧，2例为双侧。单因素分析显示，TD末端位置与心房位置（p = 0.006）、腹部位置（p = 0.042）、内脏反位类型（p = 0.036）、肺梗阻的存在（p = 0.041）、上腔静脉位置（p = 0.005）和主动脉弓位置（p < 0.001）相关。多因素分析显示，仅上腔静脉和主动脉弓位置与TD末端位置独立相关。
内脏反位患者的TD末端位置高度可变。上腔静脉和主动脉弓位置与TD末端位置独立相关。内脏反位类型与TD末端位置无独立相关性。这些数据有助于提高对内脏反位患者解剖变异的理解，可能有助于淋巴干预的规划。
