{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:30:40Z","timestamp":1792042240018,"version":"4.4.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Lymphatic embolization therapy has proven effective for Fontan failure from plastic bronchitis or protein-losing enteropathy but not when multiple lymphatic compartments are involved; furthermore, embolization does not alter the underlying pathophysiology of lymphatic dysfunction. A technique for transcatheter thoracic duct decompression (TDD), rerouting the thoracic duct to the pulmonary venous atrium to treat multicompartment lymphatic failure is described and early outcomes presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Initially covered stents were used to channel the innominate vein flow inside of the cavopulmonary pathway into the pulmonary venous atrium. A modified approach was developed where covered stents redirected innominate vein directly to the left atrium via an extravascular course. Baseline and follow-up data on all patients undergoing TDD were reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twelve patients underwent TDD between March 2018 and February 2021 at a median age of 12 (range: 2\u201322) years. Lymphatic failure occurred in median of 3 compartments per patient (protein-losing enteropathy, ascites, pleural effusions, plastic bronchitis); 10 patients had lymphatic embolizations before TDD. TDD method was intra-Fontan tunnel in 4, direct approach in 7, and other in 1. There were no major procedural complications; 6 patients underwent subsequent procedures, most commonly to treat endoleaks. Lymphatic failure resolved in 6 patients, improved in 2, and was unchanged in 4 at 6 (range: 1\u201320) months follow-up. One patient died after TDD from Fontan failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>TDD is a promising new treatment for the failing Fontan physiology from multicompartment lymphatic failure. Additional work is needed to refine the technique and define optimal candidates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.121.011733","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T14:00:46Z","timestamp":1658239246000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Transcatheter Thoracic Duct Decompression for Multicompartment Lymphatic Failure After Fontan Palliation"],"prefix":"10.1161","volume":"15","author":[{"given":"Christopher L.","family":"Smith","sequence":"first","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Dori","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6023-1634","authenticated-orcid":true,"given":"Michael L.","family":"O\u2019Byrne","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3791-8280","authenticated-orcid":true,"given":"Andrew C.","family":"Glatz","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7362-0935","authenticated-orcid":true,"given":"Jonathan J.","family":"Rome","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of 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