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Thoracic duct drainage patterns in heterotaxy.

Daniel A Castellanos1, Emily M Bucholz2, Katherine Bai3

  • 1Department of Cardiology, Boston Children's Hospital, Boston, MA, United States; Department of Pediatrics, Harvard Medical School, Boston, MA, United States.

Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance
|June 23, 2024
PubMed
Summary

Thoracic duct (TD) drainage is highly variable in heterotaxy. Superior vena cava and aortic arch sidedness are key predictors of TD sidedness in these congenital heart disease patients.

Keywords:
Cardiovascular magnetic resonance imagingCongenital heart diseaseHeterotaxyLymphaticThoracic duct

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Area of Science:

  • Cardiovascular Imaging
  • Thoracic Anatomy
  • Lymphatic Physiology

Background:

  • Disordered lymphatic drainage is frequent in congenital heart disease (CHD).
  • Thoracic duct (TD) drainage patterns in heterotaxy are not well-defined.
  • Understanding TD anatomy is crucial for managing lymphatic complications in CHD.

Purpose of the Study:

  • To describe terminal TD sidedness in patients with heterotaxy.
  • To identify anatomic variables associated with TD sidedness in heterotaxy.
  • To enhance understanding of lymphatic anatomy in complex CHD.

Main Methods:

  • Retrospective cardiovascular magnetic resonance imaging study (July 2019-May 2023).
  • Included patients with asplenia, polysplenia, or pulmonary/abdominal situs inversus (PASI) plus CHD.
  • Assessed terminal TD sidedness (left, right, or bilateral).

Main Results:

  • Terminal TD visualized in 56 of 115 (49%) eligible patients.
  • TD was left-sided (25), right-sided (29), or bilateral (2).
  • Superior vena cava and aortic arch sidedness were independently associated with terminal TD sidedness on multivariable analysis.

Conclusions:

  • Terminal TD sidedness exhibits significant variability in heterotaxy.
  • Superior vena cava and aortic arch sidedness are independent predictors of TD sidedness.
  • Findings improve understanding of heterotaxy anatomy and aid lymphatic intervention planning.