{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:26:18Z","timestamp":1779891978417,"version":"3.53.1"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,10,9]],"date-time":"2019-10-09T00:00:00Z","timestamp":1570579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"de Kleine Hartjes"},{"name":"Eddy Merckx Research Foundation"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To determine the feasibility and clinical result of selective embolization of hepatoduodenal or paratracheal lymphatics in Fontan patients with protein\u2010losing enteropathy (PLE) or plastic bronchitis (PB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Dilated lymph vessels in periportal (PLE) or paratracheal (PB) position were percutaneously punctured with a 22G Chiba needle. Intralymphatic position was confirmed by water soluble contrast injection with drainage to hepatoduodenal or tracheal fistulae. After flushing with 10% glucose solution, occlusion of hepatoduodenal or paratreacheal lymphatics was effected by injection of 1\u20134 cc mixture 4\/1 of Lipiodol\/<jats:italic>n<\/jats:italic>\u2010butyl cyanoacrylate (n\u2010BCA; Histoacryl).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven patients with proven PLE were treated with periportal lymphatic embolization 10.7 (range: 6.6\u201313.5) years after the Fontan operation. The Fontan operation was performed at a median age of 3.7 (range: 2.9\u20135.7) years and PLE started a median of 3.1 (range: 0.9\u20134.7) years later. Five patients required a second procedure 2\u20138 months later. Complications were limited (spillage of glue in portal branch, transient cholangitis, and caustic duodenal bleeding). Six of seven patients reported significant improvement in quality of life and normalization of albumin levels after limited follow\u2010up (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01). One patient (Fontan at 2.9\u2009years; age 16.4\u2009years) had PB for 2\u2009years. Selective transthoracic cone\u2010beam\u2010directed puncture of left and right paratracheal lymphatics with n\u2010BCA embolization of distal lymphatic fistulae resulted in lasting absence of tracheal casts (11\u2009months).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Embolization of periportal\/peritracheal lymphatics is a promising technique in Fontan patients with PLE\/PB. Larger series are required to determine incidence and reasons of success\/failure, with long\u2010term results and effects on liver function.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.28501","type":"journal-article","created":{"date-parts":[[2019,10,9]],"date-time":"2019-10-09T13:25:45Z","timestamp":1570627545000},"page":"996-1002","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Percutaneous embolization of lymphatic fistulae as treatment for protein\u2010losing enteropathy and plastic bronchitis in patients with failing Fontan circulation"],"prefix":"10.1002","volume":"94","author":[{"given":"Geert","family":"Maleux","sequence":"first","affiliation":[{"name":"Interventional Radiology University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Storme","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Congenital Cardiology 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