{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T05:15:24Z","timestamp":1735881324855,"version":"3.32.0"},"reference-count":6,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Lymphatic flow abnormalities are central to the development of protein losing enteropathy, plastic bronchitis, ascites and pleural effusions in patients palliated to the Fontan circulation. These complications can occur in isolation or multicompartmental (two or more). The treatment of multicompartmental lymphatic failure aims at improving thoracic duct drainage. Re\u2010routing the innominate vein to the pulmonary venous atrium decompresses the thoracic duct, as atrial pressure is lower than systemic venous pressure in Fontan circulation. Transcatheter thoracic duct decompression is a new minimally invasive procedure that involves placing covered stents from the innominate vein to the atrium. Patients undergoing this procedure require multiple general anesthetics, presenting challenges in managing the sequelae of disordered lymphatic flow superimposed on Fontan physiology. We reviewed the first 20 patients at the Center for Lymphatic Imaging and Intervention at a tertiary care children's hospital presenting for transcatheter thoracic duct decompression between March 2018 and February 2023. The patients ranged in age from 3 to 26\u2009years. The majority had failed prior catheter\u2010based lymphatic intervention, including selective embolization of abnormal lympho\u2010intestinal and lympho\u2010bronchial connections to treat lymphatic failure in a single compartment. Fourteen had failure in three lymphatic compartments. Patients were functionally impaired (ASA 3\u20135) with significant comorbidities. Concurrent with thoracic duct decompression, three patients required fenestration closure for the resultant decrease in oxygen saturation. Ten patients had improvement in symptoms, seven had no changes and three have limited follow up. Five (25%) of these patients were deceased as of January 2024 due to non\u2010lymphatic complications from Fontan failure.<\/jats:p>","DOI":"10.1111\/pan.14891","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T11:03:39Z","timestamp":1713870219000},"page":"597-601","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anesthetic challenges in patients with multicompartmental lymphatic failure after Fontan palliation undergoing transcatheter thoracic duct decompression"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3488-8439","authenticated-orcid":false,"given":"Kirsten R.","family":"Groody","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Division of Cardiothoracic Anesthesiology The Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Department of Anesthesiology, Division of Pediatric Anesthesiology The University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan C.","family":"Nicolson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Division of Cardiothoracic Anesthesiology The Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David R.","family":"Jobes","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Division of Cardiothoracic Anesthesiology The Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000696"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/21501351231214756"},{"issue":"1","key":"e_1_2_8_4_1","article-title":"Lymphatic imaging and intervention in congenital heart disease","volume":"3","author":"Bauer C","year":"2024","journal-title":"JSCAI"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13385"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.pcsu.2020.01.002"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.121.011733"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.14891","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T10:49:22Z","timestamp":1735814962000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.14891"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,23]]},"references-count":6,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1111\/pan.14891"],"URL":"https:\/\/doi.org\/10.1111\/pan.14891","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"type":"print","value":"1155-5645"},{"type":"electronic","value":"1460-9592"}],"subject":[],"published":{"date-parts":[[2024,4,23]]},"assertion":[{"value":"2024-02-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}