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

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Mohanakumar, Sheyanth ^{[1, 2, 3, 4]} ; Kelly, Benjamin ^{[1, 2]} ; Ribeiro Turquetto, Aida Luiza ^[5] ; Alstrup, Mathias ^{[1, 2]} ; Amato, Luciana Patrick ^[5] ; Barnabe, Milena Schiezari Ru ^[5] ; Dias Silveira, Joao Bruno ^[5] ; Amaral, Fernando ^{[6, 7]} ; Manso, Paulo Henrique ^{[6, 7]} ; Jatene, Marcelo Biscegli ^[5] ; Hjortdal, Vibeke Elisabeth ^{[1, 4]}

Afiliação do(s) autor(es)

^[1] Aarhus Univ, Dept Clin Med, Aarhus - Denmark

^[2] Aarhus Univ Hosp, Dept Cardiothorac & Vasc Surg, Palle Juul Jensens Blvd 99, DK-8200 Aarhus - Denmark

^[3] Aarhus Univ Hosp, Dept Radiol, Aarhus - Denmark

^[4] Rigshosp, Dept Cardiothorac Surg, Copenhagen - Denmark

^[5] Univ Sao Paulo, Heart Inst InCor, Med Sch, Sao Paulo, SP - Brazil

^[6] Univ Sao Paulo, Ribeirao Preto Med Sch, Ribeirao Preto - Brazil

^[7] Hosp Clin, Pediat & Adult Congenital Heart Dis Unit, Ribeirao Preto - Brazil

• Tipo de documento: Artigo Científico
• Fonte: PHYSIOLOGICAL REPORTS; v. 9, n. 11 JUN 2021.
• Citações Web of Science: 0

Resumo

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. (AU)

• Processo FAPESP: 18/03606-0 - Função linfática em pacientes com circulação de Fontan
• Beneficiário: Aída Luiza Ribeiro Turquetto
• Modalidade de apoio: Auxílio à Pesquisa - Regular