Chylothorax after myocardial revascularization with the left internal thoracic artery

Pêgo-Fernandes, Paulo Manuel; Ebaid, Gustavo; Nouer, Gustavo Henrique; Munhoz, Robinson Tadeu; Jatene, Fábio Biscegli; Jatene, Adib

doi:10.1590/s0066-782x1999001000006

Cited by 10 publications

(11 citation statements)

References 9 publications

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“…If this approach is not effective defects of lymphatic ways can be cloused by pleurectomy with pleurodesis and application of anti-inflammatory agents (biotalec, antibiotics) (3,12). A pleuroperitoneal shunt could be indicated in high risk patients, with excessive chylous leak (2 week's duration, with output greater than 1000 mL/day) when preceding treatment was not successful (10).…”

Section: Discussionmentioning

confidence: 99%

“…Clinical signs may be poor at the beginning, but later, with greater volume of fluid in the pleural cavity, dyspnoea becoming a dominating complaint. With a longer course of chylothorax malnutrition sequelae may develop due to loss of proteins, immunoglobulins, lipids, electrolytes and water (5,10,12).…”

Section: Introductionmentioning

confidence: 99%

“…Chylothorax is a very rare complication in cardiac surgery (5,9,10,12). Kilic and colleagues have observed this complication in less than 0.1 % of patients who underwent coronary artery bypass surgery (8).…”

Section: Introductionmentioning

confidence: 99%

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Chylothorax – a Rare Complication after Cardiac Surgery (a Case Report)

Mandak

Habal

Stĕtina

et al. 2011

Acta Med. (Hradec Kralove, Czech Repub.)

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Chylothorax is a rare but severe complication of cardiac surgery. The authors present the case of a 76-year-old woman suffering from ischemic heart disease, after coronary artery bypass grafting that included a left internal mammary artery pedicle graft. On the ninth postoperative day the left-sided fluidothorax developed. The results of biochemical analysis were consistent with the chyle. Combined treatment with pleural drainage and total parenteral nutrition was effective.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Chylothorax – a Rare Complication after Cardiac Surgery (a Case Report)

Mandak

Habal

Stĕtina

et al. 2011

Acta Med. (Hradec Kralove, Czech Repub.)

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“…The 70-year-old patient developed chylothorax after myocardial revascularization with the internal thoracic artery, a rare complication of this procedure due to the location of the thoracic duct 15 .…”

Section: Discussionmentioning

confidence: 99%

Ligation of the thoracic duct for the treatment of chylothorax in heart diseases

Pêgo‐Fernandes

Jatene

Tokunaga

et al. 2003

Arq. Bras. Cardiol.

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If conservative treatment is not effective, surgical treatment should be considered 8 . Studies indicate that ligation of the thoracic duct and pleurodesis are efficient alternatives for resolution of chylothorax 9 .Recently, thoracic duct ligation through video-assisted thoracic surgery has been used in patients who did not respond to conservative treatment. Kirby et al 11 describe this conduct as less painful and with fewer postoperative complications.Pereira et al 12 describe the use of lymphatic ligation for the treatment of postoperative chylopericardium. However, in our country, ligation of the thoracic duct for the treatment of postoperative chylothorax is still a rare procedure, and at what point the conservative treatment should be replaced by postsurgical treatment is still controversial. Thus, our study evaluates the initial results of ligation of the thoracic tract in 4 patients with chylothorax unresponsive to conservative treatment. Case ReportsCase 1 -A four-year-old-male patient with congenital cardiopathy and cyanosis at birth with a previous history of pulmonary atresia without interventricular communication, single left ventricle, hypoplastic right ventricle with sinusoids, left pulmonary artery stenosis, and coronary artery cavitary fistulas. At 5 days of life, he underwent atrial septotomy with the Rashkind procedure, and after 2 days, he underwent a modified left Blalock Taussig shunt procedure. At 4 years old, he underwent a bidirectional Glenn operation with maintenance of the previous Blalock shunt, evolving, in the postoperative period with low cardiac output maintained with vasoactive drugs. He was discharged on the 5th postoperative day, when minor pleural effusion was suspected. A chest X-ray was indicated.After chylothorax was diagnosed, pleural drainage was started. Parenteral nutrition and fasting were introduced after 1 week. The patient evolved with significant persistence of pleural drainage. Nineteen days after the initial In children, chylothorax occurs mainly after cardiac and thoracic surgeries. One of the recommended postsurgery treatments is ligation of the thoracic tract, when all other conservative treatments have failed. We report 4 cases of chylothorax in patients who were successfully treated with this approach, which resulted in a decrease in pleural drainage without recurrent chylothorax.Chylothorax refers to the presence of lymphatic fluid in one or both pleural spaces, secondary to leakage in the thoracic duct or one of its main tributaries 1 . Quinke 2 first described traumatic chylothorax in 1875, after rupture of the thoracic duct.When chylothorax is not treated, the risk of death is high, with rates above 45% 3 , requiring, in the majority of the cases, aggressive treatment.According to DeMeester 4 , chylothorax may be according to its cause, either congenital, traumatic, neoplastic, or multiple causes. Among the traumatic causes surgical procedures with a thoracic approach may cause thoracic duct lesions, leading to the development of chylothorax. Postoperat...

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“…Various strategies during invasive management are duct ligation, pleural flap cover, biological sealants and suturing of the leaking area [7]. If a delayed diagnosis is made, lavage and pleurodesis should be done through VATS because adhesions in the area of thoracic duct following surgery will make dissection in this area very difficult and dangerous [34]. Most authors have preferred a left thoracotomy or VATS and clipping or ligation of the leakage area but a right thoracotomy and mass ligation of the duct at the diaphragm has also been done [35].…”

Section: Invasive Managementmentioning

confidence: 99%