Lymph circulation in congestive heart failure: effect of external thoracic duct drainage

The lymphatic circulation was evaluated after cannulation of the cervical thoracic duct in 12 patients with severe intractable congestive heart failure. After venting the distended duct, lymph flowed rapidly under increased pressure, and signs and symptoms of circulatory congestion were dramatically relieved. Dyspnea, orthopnea, anorexia, abdominal discomfort, distended neck veins, hepatomegaly, peripheral and scrotal edema, and ascites diminished or disappeared. Central venous pressure fell and armto-tongue circulation time decreased. In some patients arterial pressure, amplitude of peripheral pulses, central venous Po 2 , and urinary output rose further suggesting enhanced cardiac output. Considered together with previous observations in experimental animals, the findings indicate that elevated systemic venous pressure greatly increases formation of thoracic duct lymph but at the same time impedes the return of lymph into the great veins. While therapeutic drainage of lymph from the thoracic duct in patients with cardiac failure is limited, the capacity of the lymphatic system to transport excess capillary filtrate back to the blood stream constitutes a major control mechanism regulating the manifestations of this disorder.