{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:30:38Z","timestamp":1792042238680,"version":"4.4.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,6,20]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">In the palliative pathway of single\u2010ventricle physiology, lymphatic abnormalities on T2\u2010weighted magnetic resonance imaging have been shown after the Glenn operation. It is believed that postsurgical hemodynamic changes contribute to the lymphatic changes.However, little is known about how early these abnormalities occur. Our purpose was to determine if lymphatic abnormalities occur as early as before the Glenn operation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We retrospectively reviewed patients with single\u2010ventricle physiology and a T2\u2010weighted magnetic resonance imaging scan before their Glenn operation (superior cavopulmonary connection) at The Children's Hospital of Philadelphia from 2012 to 2022. Lymphatic perfusion patterns on T2\u2010magnetic resonance imaging were categorized from type 1 (no supraclavicular T2\u2010signal) to type 4 (supraclavicular, mediastinal, lung parenchymal T2\u2010signal). Types 1 and 2 were considered normal variants. Distribution of lymphatic abnormalities were tabulated, as well as secondary outcomes including chylothorax and mortality. Comparison was done using analysis of variance, Kruskal\u2013Wallis test, and Fisher's exact test. Seventy\u2010one children were included: 30 with hypoplastic left heart syndrome and 41 with nonhypoplastic left heart syndrome. Lymphatic abnormalities were present before Glenn operation in 21% (type 3) and 20% (type 4), and normal lymphatic perfusion patterns (type\u00a01\u20132) were seen in 59% of patients. Chylothorax was present in 17% (only types 3 and 4). Pre\u2010Glenn mortality and mortality at any time was significantly increased when having a type 4 lymphatic abnormality compared with types 1 and 2 (\n                      <jats:italic>P<\/jats:italic>\n                      =0.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Lymphatic abnormalities can be found on T2\u2010weighted magnetic resonance imaging in children with single\u2010ventricle physiology before their Glenn operation. Mortality and chylothorax were more prevalent with advancing grade of lymphatic abnormality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.029376","type":"journal-article","created":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T06:28:41Z","timestamp":1686810521000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Lymphatic Abnormalities on Magnetic Resonance Imaging in Single\u2010Ventricle Congenital Heart Defects Before Glenn Operation"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5283-6502","authenticated-orcid":false,"given":"Rasmus","family":"Kristensen","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery Copenhagen University Hospital \u2013 Rigshospitalet Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7472-4237","authenticated-orcid":false,"given":"Benjamin","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Aarhus University Hospital Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7835-726X","authenticated-orcid":false,"given":"Emily","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology Children\u2019s Hospital of Philadelphia Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0531-8723","authenticated-orcid":false,"given":"Yoav","family":"Dori","sequence":"additional","affiliation":[{"name":"Division of Cardiology Children\u2019s Hospital of Philadelphia Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8047-0015","authenticated-orcid":false,"given":"Vibeke E.","family":"Hjortdal","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Copenhagen University Hospital \u2013 Rigshospitalet Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951113001650"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-020-01405-y"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.13.11797"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2019180877"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-017-1576-y"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.015318"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/cphy.c180015"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-0803.2008.00201.x"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezac103"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1722178"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeac216"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.1990.258.1.R240"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.04.023"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.tvir.2016.10.002"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1413.002"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-015-3514-6"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-014-2994-0"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/ejhg.2015.175"},{"key":"e_1_3_1_20_2","first-page":"152","article-title":"Incidence and characteristics of lymphedema in Turner's syndrome","volume":"39","author":"Welsh J","year":"2006","unstructured":"Welsh J, Todd M. 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