Imaging Chylo- and Lympho-thorax in Children with Congenital Heart Defects

先天性心脏缺陷儿童的乳糜胸和淋巴胸成像

• 批准号: 9186459
• 负责人: Eva M. Sevick-Muraca
• 金额: $ 19.25万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-01 至 2018-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9186459
• 关键词: Adult; Age-Months; Bilateral; Cardiac Surgery procedures; Chest; Chest Tubes; Child; Childhood; Chyle; Chylothorax; Clinical Research; Clinical Trials Data Monitoring Committees; Complication; Congenital Heart Defects; Conscious; Critical Illness; Critically ill children; Defect; Devices; Diagnostic; Diagnostic Imaging; Diagnostic Procedure; Diet Modification; Disease Management; Dose; Drainage procedure; Extravasation; Fluorescence; Hand; Hypoplastic Left Heart Syndrome; Image; Imagery; Imaging Device; Immunologics; Incidence; Individual; Indocyanine Green; Infant; Institutional Review Boards; Intensive Care; Investigation; Laceration; Lead; Length of Stay; Ligation; Light; Liquid substance; Lymph; Lymphatic; Metabolic; Monitor; Morbidity - disease rate; Near-infrared optical imaging; Noise; Nutritional; Obstruction; Operative Surgical Procedures; Pathogenesis; Pathway interactions; Patients; Pattern; Pediatric Intensive Care Units; Pediatric cardiology; Pilot Projects; Pleural cavity; Pleural effusion disorder; Pleurodesis; Population; Procedures; Resort; Rest; Rupture; Signal Transduction; Source; Surgical Management; System; Techniques; Thoracic Duct; Time; Time Management; Tissues; Translational Research; Venous; Venous system; base; contrast imaging; detector; foot; improved; inter-institutional; lymphatic drainage; male; minimally invasive; mortality; operation; point of care; pressure; public health relevance; response; success

 DESCRIPTION (provided by applicant): Chylothorax is a rare, but serious complication in children who undergo heart surgery, and is an important factor for the length of stay in pediatric intensive care units (PICU). Incidence of these pleural effusions following cardiac surgery in children is estimated to be 1.3 - 9.2% and has increased significantly in the last two decade. Chylo- and lympho-thorax can lead to serious metabolic, immunologic, and nutritional complications, and is associated with high morbidity and mortality rate. The pathogenesis is poorly understood but is thought to arise from (i) direct damage to the thoracic duct by rupture, laceration, tear, or compression, (ii) central venous (CV) obstruction or high pressure that impedes thoracic duct drainage into the venous system, or (iii) smaller lymphatic defects that may accompany congenital heart defects. Treatments for effective management need to be based upon known mechanism, but there is no diagnostic method to interrogate the causes of pleural effusion in any individual case. Currently, management for pleural effusions is initially conservative, consisting of gut rest as well as dietary modification over a period of 3-4 weeks. Although 75 to 85% of patients respond to conservative treatment, last resort surgical treatments such as pleurodesis and thoracic duct ligation have only limited success in treating pleural effusions, probably due to their lateness of treatment. Improving the poor response to these therapies demands a better understanding of the specific lymphatic drainage mechanisms responsible. Yet the inability to dynamically image lymphatic drainage in infants within the PICU has limited the understanding of pathogenesis of pleural effusions, which in turn has impeded the application of appropriate and timely management for these critically ill children. Near-infrared fluorescence (NIRF) imaging has been successfully used in investigational studies to assess the lymphatic vasculature and its function in adults and more recently in an infant with chylothorax. In this application, we propose to conduct a pilot study of dynamic lymphatic imaging of young children and infants who present with pleural effusion. Our specific aims of the study will be (i) to adapt our current investigational NIRF imaging device to enable ambient light rejection for improved bedside application in the PICU; (ii) to use the modified device to characterize dynamic lymphatic drainage in children with pleural effusion to assess drainage pathways; and (iii) to monitor response to therapy, whether conservative treatment, pleurodesis, or thoracic duct ligation in order to gain a better understanding of the management of chylothorax.

 描述（申请人证明）：乳房胸腔是一种罕见的，但在儿童接受心脏手术的儿童或儿童居住时间（PICU）的儿童中，这些胸腔手术的发生率是1.3。 - 9.2％，在过去的二十年中显着增加。或压缩，（ii）将胸腔导管导管引流到静脉系统中，或（iii）可能伴随先天性心脏缺陷的较小的淋巴缺损，但诊断为胸腔诊断方法的高压。任何人的积液最初是保守的，包括肠道和饮食修改，在3-4周内，最后一个度假胜地的术语是胸膜术和胸腔管道的术语。可能是由于其对淋巴结的延伸机制。在这种应用中，淋巴管和成年人的功能。 （i）适应我们的研究调查设备，以使周围的拒绝在患有胸腔积液的儿童中改善对PICU的应用，以评估排水途径；结扎以更好地了解乳糜胸的管理。

项目成果

Multimodality lymphatic imaging of postoperative chylothorax in an infant with Noonan syndrome: a case report.

• DOI: 10.1186/s40001-020-00455-w
• 发表时间: 2020-11-04
• 期刊: European journal of medical research
• 影响因子: 4.2
• 作者: Pham KT;Balaguru D;Tammisetti VS;Guevara CJ;Rasmussen JC;Zvavanjanja RC;Hanfland R;Sevick-Muraca EM;Aldrich MB
• 通讯作者: Aldrich MB