Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-27T12:07:09.505Z Has data issue: false hasContentIssue false
  • English
  • Français

Role of caval venous manipulation in treatment of protein-losing enteropathy

Published online by Cambridge University Press:  01 June 2008

Shaji Menon ,
Donald Hagler ,
Frank Cetta ,
Peter Gloviczki  and
David Driscoll
Shaji Menon
Affiliation:
Departments of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
Donald Hagler
Affiliation:
Departments of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
Frank Cetta
Affiliation:
Departments of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
Peter Gloviczki
Affiliation:
Department of Surgery, Division of Vascular Surgery, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
David Driscoll*
Affiliation:
Departments of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
*
Pediatric Cardiology, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota, 55905, USA. Tel: 507-284-2511; Fax: 507-284-3968; E-mail: driscoll.david@mayo.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Protein-losing enteropathy has been associated with the Fontan operation, restrictive cardiomyopathy, constrictive pericarditis, tricuspid valvar stenosis and insufficiency, and superior caval venous obstruction. The mechanism of development of this complication of cardiac disease likely is multifactorial. We report here our experience with 3 patients with protein-losing enteropathy. Two had superior caval venous occlusion. The third patient had undergone an extracardiac Fontan operation, with stenosis of the extracardiac conduit placed to the right pulmonary artery. In all three cases, the complication was resolved by restoring unobstructed flow of blood in the superior or inferior caval vein. Since the aetiology of protein-losing enteropathy associated with cardiac disease is multifactorial, reduction of pressure in the tributaries of the superior caval vein may, in some cases, be curative. It is more difficult to cure the problem when it is associated with the Fontan operation.

Keywords

Caval venous obstructioncaval venous stentingthoracic ductspiral venous graft
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 3 , June 2008 , pp. 275 - 281
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Drake, RE, Anwar, Z, Kee, S, Gabel, JC. Intestinal lymphatic pressure increases during intravenous infusions in awake sheep. Am J Physiol 1993; 265: R703–705.Google ScholarPubMed
2.Wegria, R, Zekert, H, Walter, KE, et al. Effect of systemic venous pressure on drainage of lymph from thoracic duct. Am J Physiol 1963; 204: 284–288.CrossRefGoogle ScholarPubMed
3.JrMarshall, WH, Neyazaki, T, Abrams, HL. Abnormal protein loss after thoracic-duct ligation in dogs. N Engl J Med 1965; 273: 1092–1094.CrossRefGoogle ScholarPubMed
4.Blalock, A, Cunningham, RS, Robinson, CS. Experimental production of chylothorax by occlusion of the superior vena cava. Ann Surg 1936; 104: 359–364.CrossRefGoogle ScholarPubMed
5.Molnar, Z, Karoliny, G, Mozsik, G, Nemeth, A. Lymphogenic enteropathy from thoracic duct obstruction. Lymphology 1974; 7: 130–136.Google Scholar
6.Neyazaki, T, Kupic, E, Marshall, W, Abrams, H. Collateral lymphatico-venous communications after experimental obstruction of the thoracic duct. Radiology 1965; 85: 423–432.Google Scholar
7.Kondo, M, Nakanishi, K, Bamba, T, Hosokawa, K, Masuda, M. Experimental protein-losing gastroenteropathy, role of tissue plasminogen activator. Gastroenterology 1976; 71: 631–634.CrossRefGoogle ScholarPubMed
8.Blalock, A, Robinson, C, Cunningham, R, Gray, M. Experimental studies in lymphatic blockage. Arch Surg 1937; 34: 1049–1071.Google Scholar
9.Feldt, RH, Driscoll, DJ, Offord, KP, et al. Protein-losing enteropathy after the Fontan operation. J Thorac Cardiovasc Surg 1996; 112: 672–680.Google Scholar
10.Mertens, L, Hagler, DJ, Sauer, U, Somerville, J, Gewillig, M. Protein losing enteropathy after the Fontan operation: an international multicenter study. J Thorac Cardiovasc Surg 1998; 115: 1063–1073.CrossRefGoogle ScholarPubMed
11.Mair, DD, Puga, FJ, Danielson, GK. Late functional status of survivors of the Fontan procedure performed during the 1970s. Circulation 1992; 86: II106–II109.Google Scholar
12.Ostrow, AM, Freeze, H, Rychik, J. Protein losing enteropathy after Fontan operation: investigation into possible pathophysiologic mechanisms. Ann Thorac Surg 2006; 82: 695–701.Google Scholar
13.JrGleason, WA, Roodman, ST, Laks, H. Protein-losing enteropathy and intestinal lymphangiectasia after superior vena cava-right pulmonary artery (Glenn) shunt. J Thorac Cardiovasc Surg 1979; 77: 843–846.CrossRefGoogle ScholarPubMed
14.Ludwig, C, Tomsa, W. Die Anfänge der Lymphgefässe im Hoden. Sitzungsberichte der Mathematisch-Naturwissenschaftlichen Classe der Kaiserlichen Akademie der Wissenschaften 1861; 44: 155–156.Google Scholar
15.Dousset, B, Legmann, P, Soubrane, O, et al. Protein-losing enteropathy secondary to hepatic venous outflow obstruction after liver transplantation. J Hepatol 1997; 27: 206–210.CrossRefGoogle ScholarPubMed
16.Rychik, J, Gui-Yang, S. Relation of mesenteric vascular resistance after Fontan operation and protein-losing enteropathy. Am J Cardiol 2002; 90: 672–674.Google Scholar
17.Ohhashi, T, Watanabe, N, Kawai, Y. Effects of atrial natriuretic peptide on isolated bovine mesenteric lymph vessels. Am J Physiol 1990; 259 (1 Pt 2): H42–47.Google Scholar
18.Atchison, DJ, Johnston, MG. Atrial natriuretic peptide attenuates flow in an isolated lymph duct preparation. Eur J Physiol 1996; 431: 618–624.Google Scholar
19.Rychik, J, Piccoli, D, Barber, G. Usefulness of corticosteroid therapy for protein-losing enteropathy after the Fontan procedure. Am J Cardiol 1991; 68: 819–821.Google Scholar