The article presents the first case of simultaneous embolization of the source of lymphorrhea from the thoracic duct and balloon plasty of its ostium for the treatment of plastic bronchitis in a patient with Fontan circulation in the Republic of Belarus. The main complications of the lymphatic system in patients with Fontan circulation, including plastic bronchitis (PB), protein-losing enteropathy (PLE) and chylothorax (CT), cause high morbidity and mortality in this group of patients, the therapeutic options for such patients have remained limited for many years. The techniques developed in recent years, such as transnodal lymphangiography, dynamic contrast magnetic resonance lymphangiography, transhepatic lymphography, have allowed us to obtain good visualization of the lymphatic system and identify the main pathophysiological mechanisms leading to disruption of normal lymphatic circulation. These mechanisms include 2 factors: an increased flow of lymphatic fluid due to elevated venous pressure and the presence of anatomical features of the development of lymphatic vessels in which they are located extremely close to the serous (pleural cavity in chylothorax) or mucosal (plastic bronchitis and protein-losing enteropathy) layers. New minimally invasive interventional techniques such as thoracic duct embolization, interstitial embolization and embolization of the hepatic lymphatic vessels allow blocking abnormal lymphatic vessels, which leads to the elimination of symptoms. Single-stage embolization of the source of lymph leakage and improvement of venous outflow during balloon angioplasty of the ostium of the thoracic duct (TD) potentially improve the immediate and long-term outcome of treatment.
П. Ф. Черноглаз (Thu,) studied this question.