Resolution of Protein-Losing Enteropathy after Congenital Heart Disease Repair by Selective Lymphatic Embolization
10.5223/pghn.2019.22.6.594
- Author:
Ranjit I KYLAT
1
;
Marlys H WITTE
;
Brent J BARBER
;
Yoav DORI
;
Fayez K GHISHAN
Author Information
1. Department of Pediatrics, The University of Arizona College of Medicine, Tucson, AZ, USA. rkylat@gmail.com
- Publication Type:Case Report
- Keywords:
Protein-losing enteropathies;
Embolization, therapeutic;
Heart defects, congenital;
Cardiac surgical procedures;
Lymphatic abnormalities
- MeSH:
Adhesives;
Arteries;
Cardiac Surgical Procedures;
Child;
Child, Preschool;
Chyle;
Chylous Ascites;
Embolization, Therapeutic;
Endoscopy, Gastrointestinal;
Female;
Heart Defects, Congenital;
Heart Septal Defects, Ventricular;
Humans;
Ligation;
Lymphatic Abnormalities;
Lymphography;
Pleurodesis;
Postoperative Complications;
Protein-Losing Enteropathies;
Pulmonary Atresia;
Rehabilitation;
Serum Albumin;
Thoracic Duct;
Tomography, Emission-Computed;
Weight Gain
- From:Pediatric Gastroenterology, Hepatology & Nutrition
2019;22(6):594-600
- CountryRepublic of Korea
- Language:English
-
Abstract:
With improving survival of children with complex congenital heart disease (CCHD), postoperative complications, like protein-losing enteropathy (PLE) are increasingly encountered. A 3-year-old girl with surgically corrected CCHD (ventricular inversion/L-transposition of the great arteries, ventricular septal defect, pulmonary atresia, post-double switch procedure [Rastelli and Glenn]) developed chylothoraces. She was treated with pleurodesis, thoracic duct ligation and subsequently developed chylous ascites and PLE (serum albumin ≤0.9 g/dL) and was malnourished, despite nutritional rehabilitation. Lymphangioscintigraphy/single-photon emission computed tomography showed lymphatic obstruction at the cisterna chyli level. A segmental chyle leak and chylous lymphangiectasia were confirmed by gastrointestinal endoscopy, magnetic resonance (MR) enterography, and MR lymphangiography. Selective glue embolization of leaking intestinal lymphatic trunks led to prompt reversal of PLE. Serum albumin level and weight gain markedly improved and have been maintained for over 3 years. Selective interventional embolization reversed this devastating lymphatic complication of surgically corrected CCHD.
