{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T14:52:57Z","timestamp":1781794377373,"version":"3.54.5"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>External drainage of the thoracic duct can temporarily reduce tissue congestion and improve symptoms in patients with heart failure. However, loss of fluid limits the duration of this approach. Here, we report on our initial experience with thoracic duct drainage and autotransfusion in patients with elevated central venous pressure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This is a retrospective review of medical records of 8 patients who underwent percutaneous thoracic duct drainage with autotransfusion as part of their medical care. We reviewed clinical and procedural outcomes, laboratory data, and imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      In 5 (62.5%) patients, central venous pressure was elevated secondary to congenital heart disease, 1 (12.5%) had a lymphatic conduction disorder and trisomy 21, 1 (12.5%) had a lymphatic conduction disorder with Noonan syndrome and congenital heart disease, and 1 (12.5%) patient had severe chronic lung disease due to prematurity. Median central venous pressure was 15.5 mm\u2009Hg (range, 12\u201328), and all patients presented with severe multicompartment lymphatic failure including plastic bronchitis (12.5%), pleural effusions (37.5%), protein-losing enteropathy (62.5%), ascites (75%), and anasarca (100%). Over 7 (87.5%) patients survived to decannulation, and the median duration of autotransfusion was 11.5 days (range, 6\u2013126). There was a significant reduction in creatinine from a median of 0.63 (0.3\u20132.4) to 0.36 (0.16\u20130.8) mg\/dL (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.017). There was also a significant reduction in weight (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.017) and drainage output (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.017). There were no intraprocedural or autotransfusion-related deaths.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Thoracic duct drainage with autotransfusion can improve fluid status and end-organ function without significant complications and presents a new therapeutic option. Further studies are needed to better define indications for this procedure and long-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.125.015336","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T09:00:40Z","timestamp":1756976440000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Percutaneous Thoracic Duct Externalization and Autotransfusion in Patients With Lymphatic Failure Due to Elevated Central Venous Pressure"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0531-8723","authenticated-orcid":true,"given":"Yoav","family":"Dori","sequence":"first","affiliation":[{"name":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0464-8176","authenticated-orcid":true,"given":"Erin","family":"Pinto","sequence":"additional","affiliation":[{"name":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Biroc","sequence":"additional","affiliation":[{"name":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0030-7013","authenticated-orcid":true,"given":"Ryan","family":"Callahan","sequence":"additional","affiliation":[{"name":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6815-4506","authenticated-orcid":true,"given":"Jessica","family":"Tang","sequence":"additional","affiliation":[{"name":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"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":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9066-1447","authenticated-orcid":true,"given":"Brooke","family":"Ford","sequence":"additional","affiliation":[{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2710-1779","authenticated-orcid":true,"given":"Danish","family":"Vaiyani","sequence":"additional","affiliation":[{"name":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6583-6517","authenticated-orcid":true,"given":"Aaron G.","family":"DeWitt","sequence":"additional","affiliation":[{"name":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Division of Cardiac Critical Care (A.G.DW.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Merrill","sequence":"additional","affiliation":[{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Digvijay","family":"Shinde","sequence":"additional","affiliation":[{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuelle","family":"Favilla","sequence":"additional","affiliation":[{"name":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2177-3032","authenticated-orcid":true,"given":"Rachel","family":"Shustak","sequence":"additional","affiliation":[{"name":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2147-7150","authenticated-orcid":true,"given":"Fernando A.","family":"Escobar","sequence":"additional","affiliation":[{"name":"Department of Radiology (F.A.E., G.K., A.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0892-0290","authenticated-orcid":true,"given":"Ganesh","family":"Krishnamurthy","sequence":"additional","affiliation":[{"name":"Department of Radiology (F.A.E., G.K., A.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0180-4719","authenticated-orcid":true,"given":"Abhay","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Department of Radiology (F.A.E., G.K., A.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"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":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3837-8338","authenticated-orcid":true,"given":"Christopher L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children\u2019s Hospital of Philadelphia, PA."},{"name":"Jill and Mark Fishman Center for Lymphatic Disorders, Philadelphia, PA (Y.D., E.P., L.B., J.T., B.F., D.V., A.G.D.W., D.M., D.S., E.F., R.S., F.A.E., G.K., A.S., J.J.R., C.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.04.090"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-020-01405-y"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1896.sp000596"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000560"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.39.6.723"},{"key":"e_1_3_3_7_2","first-page":"51","article-title":"Clinical usefulness of thoracic duct cannulation.","volume":"15","author":"Dumont AE","year":"1969","unstructured":"Dumont AE, Witte MH. Clinical usefulness of thoracic duct cannulation. Adv Intern Med. 1969;15:51\u201371.","journal-title":"Adv Intern Med"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196310312691804"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.36.4.539"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjtc.2021.01.045"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/2150135120905656"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.pcsu.2020.01.002"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.02.046"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/circinterventions.121.011733"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.28446"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-020-0379-7"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sempedsurg.2024.151419"}],"container-title":["Circulation: Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCINTERVENTIONS.125.015336","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T14:08:19Z","timestamp":1781791699000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCINTERVENTIONS.125.015336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":16,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1161\/CIRCINTERVENTIONS.125.015336"],"URL":"https:\/\/doi.org\/10.1161\/circinterventions.125.015336","relation":{},"ISSN":["1941-7640","1941-7632"],"issn-type":[{"value":"1941-7640","type":"print"},{"value":"1941-7632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2025-03-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}