The effect of cardiopulmonary lymphatic obstruction on heart and lung function

Many thoracic surgical procedures involve excision or destruction of intrathoracic and mediastinal lymphatics. It is widely assumed that the mediastinal lymphatic system is surgically expendable, and that destruction of mediastinal lymphatics has no significant adverse physiological effect. Cardiac lymphatic obstruction may give rise to cardiac lymphedema and impaired cardiac function. Similarly, obstruction of pulmonary lymphatics may result in pulmonary perivascular lymphedema, endothelial injury, and pulmonary artery hypertension. This review summarizes the possible deleterious effects of intrathoracic lymphatic destruction and the benefits of pharmacological and surgical enhancement of active lymph drainage.