Yoav Dori, MD, PhD, Interventional Cardiologist, Director of Pediatric Lymphatic Imaging and Interventions and Lymphatic Research, Cardiac Center at Children’s Hospital of Philadelphia talks about using poppy seed oil to treat a patient who had fluid leaking into her lungs.
Interview conducted by Ivanhoe Broadcast News in November 2017.
So we interviewed Cortney yesterday and Lilly looks like a perfectly healthy child, one thing Cortney said is, after she was born when she had a procedure in utero and after birth she was ready to go home and you came in and you said, nope I need to take another look. What was it that you suspected and what actually happened to her?
Dr. Dori: So she was actually diagnosed with chylothorax, they did what is called a TA shunt, so they drained the fluid out of her chest. Kids who have that finding in utero, after birth are going to have a certain kind of lymphatic abnormality, which we call abnormal pulmonary lymphatic perfusion or another name, neonatal chylothorax. We have been doing this now for a few years, previously when there was nothing much more to do for them; a lot of kids had this, they used to manage it conservatively and we did not use the imaging and they used to send them home or stay in the hospital until this resolved. After we started looking at these kids with some of the imaging that we developed already here, we learned about how this actually works. When she was born with a history of a shunt, we said do not send her home yet, we know what she has, and we know that we can treat it with actually a very conservative kind of treatment; which we did for her and it worked perfectly fine and she is doing perfectly fine now.
So we heard about the super glue as it was referred to properly in layman’s terms, what type of material is it that binds that together and part two of that is did you create a kind of new channel system for the lymphatic fluid to flow through?
Dr. Dori: No and in her case we did not use glue, we used oil to do the embolization. What she has; normally lymphatic channels flow from the peripheral of the body to the center toward the duct called the thoracic duct, and thoracic duct is supposed to drain up in the vein on the left side in most people. In her case she has the normal kind of flow pattern, but in addition to that, she has this abnormal flow pattern where her lungs instead of draining from the lungs towards the thoracic duct, they are flowing in the opposite direction, so they are flowing from the duct toward the lungs; so flooding the lungs with lymphatic fluid ultimately leading to these kind of leaks.
So what did you do when you went in?
Dr. Dori: What we did is injected poppy seed oil and we have found a while ago, just poppy seed oil by itself, which is actually a contrast agent, works well for embolization in babies and just the injection of a little bit of poppy seed oil through the lymph nodes in the groin. Just pushing it, massaging that oil into the lungs ultimately makes the leaks close up and that is exactly what happens. But after a few weeks, or maybe less than that, after a few days, the effusion is resolved and we just continued to manager her conservatively and she is doing amazingly well.
Sounds great, how does that poppy seed oil manage to do that and how did you come up with this idea?
Dr. Dori: So the idea that poppy seed oil can work for embolization or it also does something to the lymphatic channels, was an idea that people used a long time ago. I noticed that on people that they did in certain lymphatic conditions, so just looking at lymphatic channels with poppy seed oil sometimes their effusions went away. How exactly does poppy seed work, it causes an inflammation of the lymphatic channels and because these leaks are small, the poppy seed oil we think frankly goes where the leaks are and then causes inflammation, so the channels shut down; and that stops the leak. It does not reverse the abnormal flow but is stops the leaking from happening, they still have abnormal profusion of their lung, but they are not leaking and they mostly tend to do remarkably well, much like she is doing.
And because she was going in the wrong direction, how does it then go in the right direction?
Dr. Dori: So it does not; that is the trick, the fluid is still going in the abnormal direction in the lung and it is not leaking out and it appears that kids can do fine with that, because we have had several adults that we have treated now, that present with problems when they are in their 70’s and 80’s who have this same abnormal flow pattern that they most likely have had all their lives, so it is possible that there is a group of the population who have this abnormality and never have an issue.
What is the ultimate prognosis for her and will she have to have this procedure done again?
Dr. Dori: The bottom truth is that we do not 100 percent know, we think she is going to do perfectly fine based on our past experience with adults and children that we see with this kind of abnormal flow, so far so good. This is a new world because before for this procedure we never followed these kids and we did not even know what they had, so now we are following her and our plan is to do nothing until she is about 70, hopefully, and maybe never. Maybe she will live her entire life, which would be a normal life and do nothing else; based on what we see in adults that is a possibility, so I think the future for her is very bright.
Do you know what causes that?
Dr. Dori: We do not know exactly what really causes it, we think it is a genetic defect in their lymphatic channels, but again it is possible that there is a certain percentage of the population where this is just a variant of what people have and in some people this shows up as problems like in her chylothorax, or it is just some kind of genetic defect that creates and channel problem in the lungs that ultimately causes the lungs to flow in the opposite direction; but that is future work that we will have to find out.
END OF INTERVIEW
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