The Effect of Cardiopulmonary Lymphatic Obstruction on Heart and Lung Function

Many thoracic surgical procedures involve excision or destruction of intrathoracic and mediastinal lymphatics. It is widely assumed that the mediastinal lymphatic system is surgically expendable, and that destruction of mediastinal lymphatics has no significant adverse physiological effect. Cardiac lymphatic obstruction may give rise to cardiac lymphedema and impaired cardiac function. Similarly, obstruction of pulmonary lymphatics may result in pulmonary perivascular lymphedema, endothelial injury, and pulmonary artery hypertension. This review summarizes the possible deleterious effects of intrathoracic lymphatic destruction and the benefits of pharmacological and surgical enhancement of active lymph drainage.

Key words:

Cardiac lymphatic obstruction - Pulmonary lymphatic obstruction - Endothelial injury - Lymphedema - Pulmonary hypertension

References

• 1 Leeds S E, Uhley H N, Teleszky L B. Direct cannulation and injection lymphangiography of the canine cardiac and pulmonary efferent mediastinal lymphatics in experimental congestive heart failure.  Invest Radiol. 1981;  16 193-200
• 2 Leeds S E, Uhley H N, Meister R B. Application of direct cannulation and injection lymphangiography to the study of the canine cardiac and pulmonary efferent mediastinal lymphatics.  Invest Radiol. 1979;  14 70-78
• 3 Gabella G. Lymphatic system. In: Williams PL (editor) Gray's Anatomy. New York; Churchill Livingstone 1995 38th ed: 1605-1626
• 4 Allen L. Lymphatics and lymphoid tissues.  Annu Rev Physiol. 1967;  29 197-224
• 5 Rudbeck O. Nova exervitatio anatomia exhibens ductus hepatico aquosos et vasa glandularum serosa, nunc primum inventa, aeneisque figuris delineata. Upsala: Arosiae 1653
• 6 Patek P R. The morphology of the lymphatics of the mammalian heart.  Am J Anat. 1939;  64 203-234
• 7 Eberth C J, Belajeff A. Über die lymphgefasse des Herzens.  Virchow's Arch. 1866;  37 124-131
• 8 Miller A J, Pick R, Katz L N. Lymphatics of the mitral valve of the dog. Demonstration and discussion of possible significance.  Circ Res. 1961;  9 1005-1009
• 9 Miller A J, Pick R, Katz L N. The importance of the lymphatics of the mammalian heart: experimental observations and some speculations.  Circulation. 1964;  29 485-487
• 10 Drinker C K, Warren M F, Maurer F W, Mccarell J D. The flow, pressure and composition of cardiac lymph.  Am J Physiol. 1940;  130 43-55
• 11 Allison P R, Sabiston D R Jr. Experimental studies on the cardiac lymphatics.  Surg Forum. 1957;  8 271-274
• 12 Kampmeier O F. On the lymph flow of the human heart, with reference to the development of the channels and the first appearance, distribution, and physiology of their valves.  Am Heart J. 1928;  4 210-222
• 13 Maurer F W. The effects of decreased blood oxygen and increased blood carbon dioxide on the flow and composition of cervical and cardiac lymph.  Am J Physiol. 1940;  131 331-348
• 14 Miller A J, Ellis A, Katz L N. Cardiac lymph: flow rates and composion in dogs.  Am J Physiol. 1964;  206 63-66
• 15 Laine G A, Granger H J. Microvascular, interstitial, and lymphatic interactions in normal heart.  Am J Physiol. 1985;  249 H834-H842
• 16 Sun S C, Lie J T. Cardiac lymphatic obstruction: ultrastructure of acute-phase myocardial injury in dogs.  Mayo Clin Proc. 1977;  52 785-792
• 17 Ludwig L L, Schertel E R, Pratt J W, McClure D E, Ying A J, Heck C F. et al . Impairment of left ventricular function by acute cardiac lymphatic obstruction.  Cardiovasc Res. 1997;  33 164-171
• 18 Miller A J, Pick R, Katz L N. Ventricular endomyocardial pathology produced by chronic cardiac lymphatic obstruction in the dog.  Circ Res. 1960;  8 941-947
• 19 Kline I K, Miller A J, Katz L N. Cardiac lymph flow impairment and myocardial fibrosis: effects of chronic obstruction in dogs.  Arch Path. 1963;  76 424-433
• 20 Symbas P N, Cooper T, Gantner G E Jr, Willman V L. Lymphatics of the heart: anatomic effects following interruption of the drainage of the cardiac lymph.  Arch Path. 1966;  81 573-575
• 21 Symbas P N, Schlant R C, Gravanis M B, Shepherd R L. Pathologic and functional effects on the heart following interruption of the cardiac lymph drainage.  J Thorac Cardiovasc Surg. 1969;  57 577-584
• 22 Miller A J, Pick R, Katz L N. Ventricular endomyocardial changes after impairment of cardiac lymph flow in dogs.  Brit Heart J. 1963;  25 182-190
• 23 Ullal S R, Kluge T H, Gerbode F. Funtional and pathologic changes in the heart following chronic cardiac lymphatic obstruction.  Surgery. 1972;  71 328-334
• 24 Foldi M, Braun P, Papp M, Horvath I. Changes in serum transaminase activity following myocardial damage due to lymphatic congestion.  Nature. 1959;  183 1333-1334
• 25 Jellinek H, Gabor G, Solti F, Veress B. The problem of the coronary changes due to disturbance of vascular wall permeability.  Angiology. 1967;  18 179-187
• 26 Miller A J, DeBoer A, Palmer A. The role of the lymphatic system in coronary atherosclerosis.  Med Hypotheses. 1992;  37 31-36
• 27 Uhley H N, Leeds S E, Sung M A, Patel S, Lobos E. The subendocardial lymphatics of the canine heart: a possible role of the lymphatics in the genesis of conduction disturbances and arrhythmias.  Am J Cardiol. 1972;  29 367-371
• 28 Szlavy L, Koster K, de Courten A, Hollenberg N K. Early disappearance of lymphatics draining ischemic myocardium in the dog.  Angiology. 1987;  38 73-84
• 29 Szlavy L, Adams D F, Hollenberg N K, Abrams H L. Cardiac lymph and lymphatics in normal and infarcted myocardium.  Am Heart J. 1980;  100 323-331
• 30 Taira A, Uehara K, Fukuda S, Takenaka K, Koga M. Active drainage of cardiac lymph in relation to reduction in size of myocardial infarction: an experimental study.  Angiology. 1990;  41 1029-1036
• 31 Yotsumoto G, Moriyama Y, Yamaoka A, Taira A. Experiment study of cardiac lymph dynamics and oedema formation in ischemia/reperfusion injury: with reference to the effect of hyaluronidase.  Angiology. 1998;  49 299-305
• 32 Wywodzoff D W. Die lymphwege der lunge.  Wiener Med Jahrg. 1866;  11 3
• 33 Klein E. The Anatomy of the Lymphatic System. Vol. II. London; Adrien Delahaye 1875
• 34 Sappy P C. Anatomie, Physiologie, Pathologie de Vaisseaux Lymphatiques Consideres Chezl'homme et les Vertebres. Paris; Delahaye et leroshier 1874
• 35 Lauweryns J M. The lymphatic vessels of the neonatal rabbit lung.  Acta Anat. 1966;  63 427-433
• 36 Lauweryns J M. The juxta-alveolar lymphatics in the human lung.  Am Rev Respir Dis. 1970;  102 877-885
• 37 Rodrigues Grande N, Ribeiro J, Soares M, Carralho E. The lymphatic vessels of the lung: morphological study.  Acta Anat. 1983;  115 302-309
• 38 Drinker C K, Hardenbergh E. Absorption from pulmonary alveoli.  J Exptl Med. 1947;  86 7-17
• 39 Meyer E C, Ottaviano R. Pulmonary collateral lymph flow detection using lymph oxygen tensions.  J Appl Physiol. 1972;  32 806-811
• 40 Meyer E C, Ottaviano R. Right lymphatic duct distribution volume in dogs.  Circ Res. 1974;  35 197-203
• 41 Vreim C E, Ohkuda K, Staub N C. Proportions of dog lung lymph in the thoracic and right lymph ducts.  J Appl Physiol. 1977;  43 894-898
• 42 Kambara K, Longworth K E, Serikov V B, Staub N C. Effect of interstitial oedema on lung lymph flow in goats in the absence of filtration.  J Appl Physiol. 1992;  72 1142-1148
• 43 Mitzner W, Sylvester J T. Lymph flow and lung weight in isolated sheep lungs.  J Appl Physiol. 1986;  61 1830-1835
• 44 Drake R E, Allen S J, Williams J P, Laine G A, Gabel J C. Lymph flow from oedematous dog lungs.  J Appl Physiol. 1987;  62 2416-2420
• 45 Pine M B, Beach P M, Cottrell T S, Scola M, Turino G M. The relationship between right duct lymph flow and extravascular lung water in dogs given α-naphthylthiourea.  J Clin Invest. 1979;  58 482-492
• 46 Rabin E R, Meyer E C. Cardiopulmonary effects of pulmonary venous hypertension with special reference to pulmonary lymph flow.  Circ Res. 1960;  8 324-335
• 47 Leeds S E, Uhley H N, Sampson J J, Friedman M. Significance of changes in the pulmonary lymph flow in acute and chronic experimental pulmonary oedema.  Am J Surg. 1967;  114 254-258
• 48 Wagner E M, Blosser S, Mitzner W. Bronchial vascular contribution to lung lymph flow.  J Appl Physiol. 1998;  85 2190-2195
• 49 Kramer G C, Harms B A, Gunther R A, Renkin E M, Demling R H. The effects of hypoproteinemia on blood-to-lymph fluid transport in sheep lung.  Cire Res. 1981;  49 1173-1180
• 50 Zarins C K, Rice C L, Peters R M, Virgilio R W. Lymph and pulmonary response to isobaric reduction in plasma oncontic pressure in baboons.  Circ Res. 1978;  43 925-930
• 51 Coates G, O'Brodovich H, Jeffries A L, Gray G W. Effects of exercise on lung lymph flow in sheep and goats during normoxia and hypoxia.  J Clin Invest. 1984;  74 133-141
• 52 Drake R E, Weiss D, Gabel J C. Active lymphatic pumping and sheep lung lymph flow.  J Appl Physiol. 1991;  71 99-103
• 53 Ravi K, Bonham A C, Kappagoda C T. Effect of pulmonary lymphatics obstruction on respiratory rate and airway rapidly adapting receptor activity in rabbits.  J Physiol. 1994;  480 163-170
• 54 Ravi K, Bravo M, Kappagoda C T. Effect of pulmonary lymphatic obstruction on rabbit urine flow.  J Physiol. 1997;  505 833-840
• 55 Cui Y. Pulmonary haemodynamic effects resulting from mediastinal lymphatic obstruction in anaesthetized rabbits.  Med Sci Res. 1999;  27 345-348
• 56 Gautier H, Bonora M. Vagus nerves and pulmonary artery pressure in the conscious and anaesthetized cats using different levels of oxygenation.  Journal de Physiologie. 1980;  76 835-843
• 57 Rubin L J. ACCP consensus statement. Primary pulmonary hypertension.  Chest. 1993;  104 236-250
• 58 Voelkel N F, Tuder R M. Cellular and molecular mechanisms in the pathogenesis of severe pulmonary hypertension.  Eur Respir J. 1995;  8 2129-2138
• 59 Cool C D, Kennedy D, Voelkel N F, Tuder R M. Pathogenesis and evolution of plexiform lesions in pulmonary hypertension associated with scleroderma and human immunodeficiency virus infection.  Hum Pathol. 1997;  28 434-442
• 60 Ryan T J. Disorders affecting the lymphatic system. In: Jarrett A, ed. The Physiology and Pathophysiology of the Skin. London; Academic Press 1978: 1781-2008
• 61 Ryan T J. Disorders affecting the lymphatic system. In: Jarrett A, ed. The Physiology and Pathophysiology of the Skin. London; Academic Press 1978: 1755-1780
• 62 Ryan T J. Structure and function of lymphatics.  J Invest Dermatol. 1989;  93 18-24
• 63 Mackersie R C, Christensen J, Lewis F R. The role of pulmonary lymphatics in the clearance of hydrostatic pulmonary oedema.  J Surg Res. 1987;  43 495-504
• 64 Fukure M, Serikov V B, Jerome E H. Recovery from increased pressure or increased leakiness oedema in perfused sheep lungs.  J Appl Physiol. 1994;  77 184-189
• 65 Uhley H N, Leeds S E, Sampson J J, Friedman M. Role of pulmonary lymphatics in chronic pulmonary oedema.  Circ Res. 1962;  11 966-970
• 66 Hunter D N, Morgan C J, Yacoub M, Evans T W. Pulmonary endothelial permeability following lung transplantation.  Chest. 1992;  102 417-421
• 67 Thomas P A. Physiologic sufficiency of regenerated lung lymphatics.  Ann Surg. 1980;  192 162-168
• 68 Ruggiero R, Muz J, Fietsam R. et al . Reestablishment of lymphatic drainage after canine lung transplantation.  J Thorac Cardiovasc Surg. 1993;  106 167-171
• 69 Geissler H J, Allen S J. Myocardial fluid balance: pathophysiology and clinical implications.  Thorac Cardiovasc Surg. 1998;  46 242-247
• 70 Pogatsa G, Dubecz E, Gabor G. The role of myocardial oedema in left ventricular diastolic stiffness.  Basic Res Cardiol. 1979;  71 263-269
• 71 Laine G A, Allen S J. Left ventricular myocardial oedema.  Circ Res. 1991;  68 1713-1721
• 72 Kim K M. Apoptosis and calcification.  Scanning Microsc. 1995;  9 1137-1178