Effect of systemic venous pressure on drainage of lymph from thoracic duct

1963 ◽  
Vol 204 (2) ◽  
pp. 284-288 ◽  
Author(s):  
René Wégria ◽  
Horst Zekert ◽  
Kenneth E. Walter ◽  
Richard W. Entrup ◽  
Christian De Schryver ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Thoracic Duct ◽  
Lymphatic System ◽  
Venous Pressure ◽  
Pressure Rise ◽  
Thoracic Duct Lymph ◽  
Chronic Congestive Heart Failure ◽  
Duct Lymph ◽  
Left Innominate Vein

In acute experiments on the anesthetized dog, partial or complete occlusion of the left innominate vein resulting in a rise of pressure in the venous territory into which the thoracic duct drains, commensurate with the venous pressure rise seen in congestive heart failure, reduces the flow of lymph in the thoracic duct. This decrease in thoracic duct lymph flow is due, at least partially, to the accumulation of lymph in the lymphatic system and possibly the intercellular spaces. The present acute experiments suggest the possibility that this factor may play a role in the genesis of the systemic edema of chronic congestive heart failure, although only chronic experiments now under way will permit definitive conclusions.

Intestinal lymphatic pressure increases during intravenous infusions in awake sheep

1993 ◽  
Vol 265 (3) ◽  
pp. R703-R705 ◽  
Author(s):  
R. E. Drake ◽  
Z. Anwar ◽  
S. Kee ◽  
J. C. Gabel
Keyword(s):  
Body Weight ◽  
Lymphatic System ◽  
Venous Pressure ◽  
Ringer Solution ◽  
Lymph Flow ◽  
The Body ◽  
Intravenous Fluid ◽  
Thoracic Duct Lymph ◽  
Duct Lymph ◽  
Intestinal Lymphatics

Intravenous fluid infusions cause increased venous pressure and increased lymph flow throughout the body. Together the increased lymph flow and increased venous pressure (the outflow pressure to the lymphatic system) should increase the pressure within the postnodal intestinal lymphatics. To test this, we measured the pressure in postnodal intestinal lymphatics and the neck vein pressure in five awake sheep. At baseline, the neck vein pressure was 1.2 +/- 1.5 (SD) cmH2O and the lymphatic pressure was 12.5 +/- 1.7 cmH2O. When we infused Ringer solution intravenously (10% body weight in approximately 50 min), the neck vein pressure increased to 17.3 +/- 0.9 cmH2O and the lymphatic pressure increased to 24.6 +/- 3.8 cmH2O (both P < 0.05). In two additional sheep, the thoracic duct lymph flow rate increased from 0.8 +/- 0.4 ml/min at baseline to 5.5 +/- 2.0 ml/min during the infusions. Our results show that postnodal intestinal lymphatic pressure may increase substantially during intravenous fluid infusions. This is important because increases in postnodal lymphatic pressure may slow lymph flow from the intestine.

scholarly journals RENAL VENOUS PRESSURE IN CHRONIC CONGESTIVE HEART FAILURE 1

1950 ◽  
Vol 29 (3) ◽  
pp. 342-348 ◽  
Author(s):  
Morton H. Maxwell ◽  
Ernest S. Breed ◽  
Irving L. Schwartz
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Venous Pressure ◽  
Chronic Congestive Heart Failure

scholarly journals Internal jugular vein ultrasound in patients with chronic congestive heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Thacker ◽  
D Amaratunga ◽  
K Shah ◽  
R Watson ◽  
A Singh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Internal Jugular Vein ◽  
Predictive Value ◽  
Jugular Vein ◽  
Venous Pressure ◽  
Right Atrial ◽  
Chronic Congestive Heart Failure ◽  
Obese Patients ◽  
Bedside Test

Abstract Background Bedside assessment of intravascular volume in patients with chronic congestive heart failure (CHF) is often difficult. Under- and over-diuresis are common causes of morbidity and readmissions in these patients. Purpose We hypothesized that ultrasound assessment of the internal jugular vein would be easier and more reproducible than clinically assessing jugular venous pressure (JVP). Our goal was to create a bedside test that would be simpler to learn than inferior vena cava (IVC) assessment and easier to perform in obese patients. Methods Adults with HF (n=53, 52% men, mean age 65 years, mean BMI 29.6 kg/m2, mean LVEF 44%) scheduled for right heart catheterization (RHC) had an ultrasound of their right internal jugular (RIJ) vein performed immediately prior. Cross-sectional area of RIJ was measured during normal breathing with patients at 90 and 45 degrees recumbency and was indexed by height (RIJI). JVP was also assessed clinically. Results were compared to right atrial pressure (RAP) measured by RHC. Operators were blinded to RHC results and vice versa. Results JVP was correctly assessed clinically in only 43%. RIJI at 90 and 45 degrees were significantly larger in patients with elevated RAP compared to euvolemic patients (Table). At 90 degrees, RIJI of &gt;15 predicted a RAP of &gt;10 mmHg with 68% sensitivity and 72% specificity. At 45 degrees, RIJI of &gt;10 predicted a RAP of &gt;10 mmHg with 94% sensitivity and a negative predictive value of 80% (Table). Simply being able to see the RIJ at 90 degrees (n=34) had an 82.4% positive predictive value for elevated RAP. IVC data could not be obtained on 23% of patients due to body habitus or inability to lay flat. Conclusion Ultrasonographic RIJI is more accurate than clinical assessment in patients with CHF and can be accurately performed even in obese patients. It requires only a basic linear ultrasound probe and was easily performed by clinicians at various stages of training with reproducible results. With the increased availability of bedside ultrasound in clinical practice, it is a feasible method of evaluating chronic CHF patients. FUNDunding Acknowledgement Type of funding sources: None.

Effects of outflow pressure and vascular volume loading on thoracic duct lymph flow in adult sheep

1990 ◽  
Vol 258 (1) ◽  
pp. R240-R244 ◽  
Author(s):  
R. A. Brace ◽  
G. J. Valenzuela
Keyword(s):  
Flow Rate ◽  
Thoracic Duct ◽  
Venous Pressure ◽  
Ringer Solution ◽  
Lymph Flow ◽  
Thoracic Duct Lymph ◽  
Volume Loading ◽  
Vascular Volume ◽  
Duct Lymph ◽  
Lymph Duct

Studies have shown that lymph flow rate from several tissues depends on the pressure at the outflow end of the lymphatics. The left thoracic lymph duct is the largest lymphatic vessel and it transports a majority of the body's lymph. We varied outflow pressure for the left thoracic lymph duct independent of venous pressure in six unanesthetized, nonpregnant adult ewes with chronic lymphatic and venous catheters. When outflow pressure was negative, the thoracic duct lymph flow rate was independent of outflow pressure and averaged 0.040 +/- 0.004 (SE) ml.min-1.kg body wt-1. Lymph flow began to decrease with increasing outflow pressure only when outflow pressure was significantly greater than venous pressure. Above this breakpoint, lymph flow decreased linearly with outflow pressure and ceased at an outflow pressure of 25.6 +/- 4.2 mmHg. After vascular volume loading with lactated Ringer solution, steady-state thoracic duct lymph flow increased to 351 +/- 54% of control and was independent of outflow pressure when outflow pressure was negative. As outflow pressure was elevated, lymph flow began to decrease at the same breakpoint as before volume loading, and lymph flow ceased at the same outflow pressure as before volume loading. Thus this study shows that there is a plateau where thoracic duct lymph flow rate is independent of outflow pressure. In addition venous pressure under normal or volume-loaded conditions is not an impediment to thoracic duct lymph flow in unanesthetized sheep. Large increases in venous pressure are required to totally block thoracic duct lymph flow.

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