Chylothorax following pediatric cardiac surgery

Yıldız, Okan; Öztürk, Erkut; Altin, Hüsnü Fırat; Ayyıldız, Pelin; Kaşar, Taner; İrdem, Ahmet; Ergül, Yakup; Haydın, Sertaç; Güzeltaş, Alper; Yeniterzi, Mehmet

doi:10.5606/tgkdc.dergisi.2015.10912

Cited by 6 publications

(10 citation statements)

References 17 publications

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“…[14,15] Additional well-defined complications in these patients, which may lead to prolonged mechanical ventilation following cardiac surgery and may deteriorate respiratory function, are chronic pleural effusion and chylothorax. [15,16] In consistent with the literature data, we also observed three patients (16.6%) with diaphragmatic paralysis, three (16.6%) with pleural effusion, two (11%) with chylothorax, and one (5.5%) with tracheomalacia.…”

Section: Discussionsupporting

confidence: 79%

Evaluation of tracheostomy patients in a pediatric cardiac intensive care unit: our five-year single-center experiences

Saygı¹,

Özden²,

Öztürk³

et al. 2016

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada trakeostomi uygulanan pediyatrik kardiyak yoğun bakım ünitesindeki hastalara ilişkin veriler analiz edildi.Ça lış m a pla nı: Ocak 2010 -Ocak 2015 tarihleri arasında tek bir merkezde pediyatrik kardiyak yoğun bakım ünitesinde yatan ve hastanede yatış döneminde trakeostomi uygulanan toplam 18 hasta (10 kız, 8 erkek; ort. yaş 9.4±10.5 ay; dağılım 2-42 ay) retrospektif olarak incelendi.Bul gu lar: Başlangıçta üç hastada genetik bozukluk saptandı. Kardiyak cerrahi uygulanan 1450 hastanın 10'una total düzeltme ve sekizine palyasyon yapıldı. Trakeostomi uygulanmadan geçen ortalama entübasyon süresi 41.0±12.9 gün ve ekstübasyon girişimi sayısı 4.2±0.8 idi. İki hastada nörolojik hasar vardı. Trakeostomi sonrası hastaların hiçbirinde pnömomediastinum, pnömotoraks, yara yeri enfeksiyonu ya da mediastinit gelişmedi. Bir hastada kanama nedeniyle trakeostomi revizyonu yapıldı. Hastaların hiçbirinde takip döneminde trakeal darlık gibi geç dönem trakeostomi komplikasyonları gözlenmedi. On sekiz trakeostomi hastasının altısı pediyatrik kardiyak yoğun bakım ünitesinde ve biri ise taburculuk sonrasında evde kaybedildi (mortalite %38.8). Taburcu edilen 12 trakeostomi hastasının sekizine dekanülasyon yapıldı. Üç hasta halen ev tipi ventilatör ile evde takip edilmektedir. So nuç:Trakeostomi işlemleri kardiyak cerrahi sonrası entübasyon süresi uzamış olan hastalarda düşük komplikasyon oranı ile uygulanabilir. Ancak, bu karmaşık süreçte rol oynayan çeşitli faktörler nedeniyle, morbidite ve mortalite oranı bu hasta popülasyonunda halen yüksek seyretmektedir.Anah tar söz cük ler: Kardiyak cerrahi; çocuk, pediyatrik kardiyak yoğun bakım ünitesi; uzamış entübasyon; trakeostomi. ABSTRACT Background:In this study, we analyzed the data related to pediatric cardiac intensive care unit patients undergoing tracheostomy.

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Section: Discussionsupporting

confidence: 79%

Evaluation of tracheostomy patients in a pediatric cardiac intensive care unit: our five-year single-center experiences

Saygı¹,

Özden²,

Öztürk³

et al. 2016

Turk Gogus Kalp Dama

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“…A milky, serous, or transudative chylous pleural effusion has been described in patients after cardiac surgery. The rate of chylothorax after cardiothoracic procedures has been reported as 2.4% to 5.4% in patients who have undergone cardiovascular surgery [Doğan 2004;Hillerdal 1997;Yıldız 2015;Kara 2014]. It has been detected more frequently in the pediatric age group compared with adults [Sapmaz 2018].…”

Section: Introductionmentioning

confidence: 99%

“…It has been detected more frequently in the pediatric age group compared with adults [Sapmaz 2018]. The classic appearance of chylothorax is milky [Doğan 2004;Hillerdal 1997;Yıldız 2015], but appearance of chylothorax and pseudochylothorax may be serous or transudative [Sapmaz 2018;Cannizzaro 2006;Yeh 2013]. The presence of chylomicrons in pleural effusion is considered the gold standard in diagnosing chylothorax and pseudo-chylothorax [Doğan 2004;Hillerdal 1997;Yıldız 2015;Kara 2014;Sapmaz 2018;Cannizzaro 2006;Yeh 2013;Chan 2005].…”

Section: Introductionmentioning

confidence: 99%

“…The classic appearance of chylothorax is milky [Doğan 2004;Hillerdal 1997;Yıldız 2015], but appearance of chylothorax and pseudochylothorax may be serous or transudative [Sapmaz 2018;Cannizzaro 2006;Yeh 2013]. The presence of chylomicrons in pleural effusion is considered the gold standard in diagnosing chylothorax and pseudo-chylothorax [Doğan 2004;Hillerdal 1997;Yıldız 2015;Kara 2014;Sapmaz 2018;Cannizzaro 2006;Yeh 2013;Chan 2005]. If the triglyceride (TG) level of a pleural effusion is <2.77 mmol/L, the diagnosis of chylothorax may be excluded [Sapmaz 2018].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ten-Year Clinical Experience on Chylothorax after Cardiovascular Surgery

Kahraman

Keskin

Khalil

et al. 2020

HSF

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Background: Chylothorax or pseudo-chylothorax is a serious complication after adult and pediatric cardiac surgery. This study presents our 10-year clinical experience of chylothorax after cardiac surgery. Methods: Between January 2008 and February 2019, 4896 cardiovascular surgeries were performed in 2 tertiary clinics, with 416 patients in the pediatric age group (8.4%). Chylothorax and pseudo-chylothorax were detected in 47 patients (22 adult and 20 pediatric patients, 4.8%). Pseudo-chylothorax was seen in 5 adult patients. In 27 patients, a pleural effusion developed on the left side (64.2%). Quantities of chylomicron in pleural effusion were significant in all patients. In addition, protein and lactate dehydrogenase levels were >2.9 g/dL. The cholesterol level in the pleural effusion was >2.49 mmol/L in all patients. The mean latency period was 8 days (range 3.1 to 63.1). For the management of chylothorax, somatostatin or octreotide as a somatostatin analog was administered in 23 patients (15 adult and 8 pediatric) in the intensive care unit. Somatostatin or octreotide was administered intravenously or subcutaneously at a dose of 0.3 to 4 µg/(kg · h–1). We used dexamethasone as a steroid combined with somatostatin in patients who were resistant to medical treatment before pleurodesis or ductus closure. Classic chemical pleurodesis combined with fibrin glue was performed in 11 patients (8 adult and 3 pediatric). Surgical duct ligation, as the last option, was performed in 7 patients. Results: No mortality or morbidity was observed. Chylothorax improved with the medical approach in 23 patients within 24.2 ± 11.3 days (48.9%). We successfully performed the pleurodesis procedure using fibrin glue in addition to the classic method. The mean duration of conservative treatment was 27.1 days (range 11 to 39). After discharge from the hospital, 2 children had recurrence of chylothorax, and the ductus thoracicus was surgically ligated. No complication was seen during or after ductus ligation. Conclusions: According to our clinical experience, chylothorax is not an extremely rare complication after cardiac surgery in pediatric cardiovascular surgery. A number of patients with chylothorax may be treated medically and with diet adjustment. Medical treatment including steroid administration may be the first treatment strategy immediately after diagnosis. Classic chemical pleurodesis combined with fibrin glue may be applied in the early stages. Surgical ligation of the ductus thoracicus should be considered the last treatment option.

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“…Several mechanisms are responsible for post-operative complication of chylothorax: damage to the thoracic duct while cannulating superior vena cava during cardio-pulmonary bypass, surgical trauma to thoracic duct and/or disruption of accessory lymphatic vessels during dissection, increased central venous pressure (exceeding lymphatic pressure) after partial or complete cavo-pulmonary anastomosis and development of central venous thrombosis (both preventing drainage of the thoracic duct) [4,5]. Risk factors include [2,3] type of procedure and its complexity (1% for Risk Adjustment for Congenital Heart Surgery [RACHS] score 1 and 5.6% for RACHS score 5 and 6), low weight and height, duration of cardiopulmonary bypass and crossclamping, and presence of syndromes, in particular Down syndrome, Noonan's syndrome and Turner's Syndrome (the latter two are 4-7 times more likely to develop chylothorax due to lymphangiectasia, abnormal lymphatic collaterals and spontaneous chylothorax) [3,[9][10][11][12]. Right ventricular dysfunction after total correction of tetralogy of Fallot predisposes to chylothorax by increasing right atrial central venous pressures [13].…”

Section: Etiology and Risk Factors For Chylothorax After Congenital Hmentioning

confidence: 99%

Post-Operative Chylothorax in Children Undergoing Congenital Heart Surgery

Ahmed¹

2021

Cureus

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Chylothorax is a rare postoperative complication of congenital heart surgery. It has high morbidity with increased hospital stay and cost of treatment. Damage to the thoracic duct, disruption of accessory lymphatic vessels, and increased venous pressure exceeding that in the thoracic duct have been proposed as the possible causes of chylothorax after surgery for congenital heart disease. Prompt diagnose with early initiation of treatment will reduce the duration of drainage. Staged treatment is the general principle in managing this serious complication. Loss of chyle leads to volume, nutritional and electrolyte depletion, immunological deficiencies and hematological complications. Identifying the underlying cause and addressing it is crucial to definitive management.

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Chylothorax following pediatric cardiac surgery

Cited by 6 publications

References 17 publications

Evaluation of tracheostomy patients in a pediatric cardiac intensive care unit: our five-year single-center experiences

Evaluation of tracheostomy patients in a pediatric cardiac intensive care unit: our five-year single-center experiences

Ten-Year Clinical Experience on Chylothorax after Cardiovascular Surgery

Post-Operative Chylothorax in Children Undergoing Congenital Heart Surgery

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