Groundbreaking intervention: lymphatic catheterization prevents a heart transplant in a 6-year-old girl

For the first time in Spain, the Gregorio Marañón General University Hospital has performed lymphatic catheterization on a pediatric patient with congenital heart disease. A 6-year-old girl was born with a genetic heart defect, having only one functioning ventricle.

This is a pioneering technique , applied for the first time to a pediatric patient , which has prevented the girl from having to undergo a heart transplant . The procedure lasted 12 hours and involved more than thirty professionals, with advice from an American expert.

The patient had a genetic heart defect, having only one functioning ventricle . To alleviate this situation, these children underwent Fontan surgery, in which the cardiac surgeon redirects blood flow so that it properly reaches the lungs and the rest of the body.

However, this surgery is not without risks, as it can increase pressure in the veins that drain lymphatic circulation, causing, in some cases, the loss of lymph into the lungs or abdominal cavity and protein loss through the intestine. Specifically, this girl suffered from an abnormal accumulation of lymph in the lungs, known as chylothorax.

This condition caused a significant loss of this fluid, rich in fats, proteins, and lymphocytes essential for immune defense, leading to malnutrition and increasing his vulnerability to infections, the hospital said in a statement.

Furthermore, the child had an additional complication called plastic bronchitis , where lymph leaked into the bronchi, making breathing difficult and forming obstructive plugs inside the airways. Thus, if the problem isn't resolved, patients eventually require a heart transplant.

The procedure used was interventional lymphatic catheterization, a technique that allows access to the central lymphatic system using radiological guidance. This requires a three-phase process.

Thus, in the initial phase, the lymphatic system was accessed through a needle puncture of the lymph nodes in the inguinal and periportal region, where a contrast agent was injected, with the aim of precisely locating the affected area.

In a second phase, exceptionally and for the first time at the Marañón, a dynamic lymphangiography with magnetic resonance was carried out, a highly advanced technique that allows the lymph flow to be visualized in real time and that allowed pediatric radiologists to obtain detailed images of the lymphatic circulation in motion and thus identify exactly the origin of the lesion.

The final part was strictly limited to the lymphatic catheterization procedure. Specifically, a lymphatic malformation at the root of the problem was embolized using one-millimeter microcatheters and specific embolization material, with the goal of sealing the leak and restoring proper lymphatic circulation.

The entire complex procedure required 12 hours of work to locate the exact location of the leak, perform the embolization, and achieve permanent closure. The patient was transferred to the Pediatric ICU in good condition without complications and is now recovering on the ward.

This intervention was made possible thanks to the collaboration of a multidisciplinary team of more than 30 healthcare professionals , including pediatric radiologists, vascular interventional radiologists, pediatric interventional cardiologists, and professionals from pediatric anesthesiology, pediatric surgery, and the ICU and Pediatric Cardiology, nursing staff, and radiology technicians.

He also had the direct advice of Sanjay Sinha , an American pediatric interventional cardiologist and director of the Lymphatic Intervention in Congenital Heart Disease program at UCLA Mattel Children's Hospital in Los Angeles (USA), who traveled to the Madrid hospital.

He is one of the few experts worldwide who performs this procedure. During his visit, he praised the highly qualified professionals and the excellent quality of the Gregorio Marañón facilities , especially the images obtained in the MRI study, which are even superior to those obtained in some centers in the US.

This collaborative effort has made it possible to successfully plan and execute a highly complex technique customized to the patient's anatomy and clinical situation. The medical team at Marañón Hospital , the national referral center for congenital heart disease, will incorporate this procedure into its care offerings to avoid families having to travel to other centers abroad.

"We are finalizing the protocols and coordinating the teams to offer this procedure to children with these types of problems that so severely affect their quality of life," said José Luis Zunzunegui, Head of the Pediatric Interventional Cardiology Section. He also emphasized that "thanks to these techniques, these problems can be diagnosed even before heart surgery." This helps identify each patient's risk and anticipate possible complications.

Likewise, the cardiac surgeon can adapt the approach to avoid disrupting lymphatic circulation. This "improves surgical planning and outcome," noted Manuela Camino, head of the Pediatric Heart Transplant Department at Gregorio Marañón Hospital.