Role of Lymphatics in Heart Failure

Figure 1. Fluid filtration is governed by the Starling equation, which depends on the hydrostatic and oncotic pressures in the capillaries and the interstitium. K, constant; Palv, alveolar pressure; Ph, hydrostatic pressure; Ponc, oncotic pressure; σ, reflection coefficient. Figure is reproduced from Fudim et al.2

Figure 2. The two major lymphatic ducts (the thoracic duct and the right lymphatic duct) return lymph to the cardiovascular system by passively emptying into the venous system. Figure is reproduced from Fudim et al.2

Figure 3. Direct interstitial decongestion using the first generation of the WhiteSwell system. Figure is reproduced from Abraham et al.36

Figure 4. In the first-in-human use of the direct interstitial decongestion system in a patient with heart failure, decongesting the lymphatic system resulted in a significant increase in urine output. Figure is reproduced from Abraham et al.36

Central Illustration. Several self-propagating congestive mechanisms are involved in lymphatic dysregulation in heart failure. Although targeting the lymphatic system can potentially provide a novel treatment pathway in heart failure, there remain significant gaps in our understanding of this approach and its feasibility. HF, heart failure.