Chylothorax in Children After Congenital Heart Surgery

Chan, Shu-yan; Lau, Wendy; Wong, Wilfred Hing Sang; Cheng, Lin; Chau, Anson C.M.; Cheung, Yiu‐fai

doi:10.1016/j.athoracsur.2006.05.116

Cited by 110 publications

(126 citation statements)

References 35 publications

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“…[10] The optimal management of chylothorax is unclear because no prospective studies exist to aide in the choice of therapy since different protocols and strategies are followed in each center. [11,12] The primary modes of treatment include pleural space evacuation, the use of MCT oil-based formulas, enteric rest, and parenteral alimentation, [12,13] and these have shown a success rate of 77% within a maximum of 45 days, with an average time of approximately 12 days. [14] Previous studies have suggested that persistent chylous output for more than three weeks and lesions associated with elevated systemic venous pressure were risk factors for the failure of conservative management options.…”

Section: Discussionmentioning

confidence: 99%

Chylothorax following pediatric cardiac surgery

Yıldız¹,

Öztürk²,

Altin³

et al. 2015

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada şilotoraksın insidansı, tedavi protokolleri ve pediatrik kardiyovasküler cerrahi sonrası erken dönem bulgular üzerindeki etkisi değerlendirildi. Ça lış ma pla nı: Haziran 2011 -Haziran 2014 tarihleri arasında kliniğimizde kalp ameliyatı geçiren 1123 pediatrik hastanın kayıtları retrospektif olarak incelendi. Ameliyat sonrası şilotoraks gelişen 35 hasta (19 erkek, 16 kız; ortanca yaş 240 gün; dağılım 5 gün-15 yıl) çalışmaya dahil edildi. Bul gu lar: Şilotoraks gelişimi en sık tek ventrikül tamirlerinde saptandı (n=11, %31). Bunu aortik ark tamiri (n=9, %25), Fallot tetralojisi (n=4, %11) atriyoventriküler septal defekt tamirleri (n= 4, %11), arteriyel switch ameliyatları (n=3, %8), ventriküler septal defekt tamirleri (n=2, %6) ve diğer ameliyatlar (n=2, %6) izledi. Ortanca şilotoraks drenaj süresi dokuz gün (dağılım 2-44 gün) idi. Beslenme yönetimi yağdan fakir diyet, orta zincirli yağ asitlerinden zengin enteral beslenme ve total parenteral beslenmeyi içerdi. On dört hastaya oktreotid, dört hastaya duktus torasikus ligasyonu ve dört hastaya plörodezis uygulandı. Dokuz hastada sepsis gözlendi ve üç hasta kaybedildi. So nuç:Pediatrik kardiyak cerrahi sonrası gelişen şilotoraks nadir olmayan bir komplikasyondur. En sık tek ventrikül tamiri sonrasında gelişir ve ameliyat sonrası klinik seyir ve morbidite üzerinde anlamlı etkiye sahiptir.Anah tarsöz cük ler: Kardiyak cerrahi; çocuklar; şilotoraks. ABSTRACT Background:This study aims to evaluate the incidence, treatment protocols, and impact of chylothorax on early outcomes after pediatric cardiovascular surgery. Methods: Records of 1,123 pediatric patients who underwent heart operation at our clinic between June 2011 and June 2014 were reviewed retrospectively. Thirty-five patients (19 males, 16 females; median age 240 days; range 5 days to 15 years) who developed postoperative chylothorax were included in the study. Results: Development of chylothorax was detected most frequently in single ventricle repairs (n=11, 31%). It was followed by aortic arch repairs (n=9, 25%), tetralogy of Fallot (n=4, 1%), atrioventricular septal defect repairs (n=4, 11%), arterial switch operations (n=3, 8%), ventricular septal defect repairs (n=2, 6%), and other operations (n=2, 6%). Median duration of drainage of chylothorax was nine days (range, 2 to 44 days). Nutritional management included low lipid diet, enteral feedings enriched with mediumchain triglycerides, and total parenteral nutrition. Fourteen patients were administered octreotide, four patients were administered thoracic duct ligation, and four patients were administered pleurodesis. Sepsis was observed in nine patients and three patients died. Conclusion: Chylothorax developing after pediatric cardiac surgery is not a rare complication. It occurs most frequently after single ventricle repair and has a significant impact on postoperative clinical course and morbidity.

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Section: Discussionmentioning

confidence: 99%

Chylothorax following pediatric cardiac surgery

Yıldız¹,

Öztürk²,

Altin³

et al. 2015

Turk Gogus Kalp Dama

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“…4,6 Potential causes of chylothorax in children can vary and have been previously grouped into such categories as congenital, traumatic, related to high central venous pressure, and malignancies as well as miscellaneous causes such as benign tumors, granulomatous disease, and transdiaphragmatic movement of chylous ascites. 4,[7][8][9][10][11][12][13] Tumors have been reported to account for .50% of all cases of chylothorax, and traumas are the second major cause. 7 Therefore, patients presenting with nontraumatic or idiopathic chylothorax should undergo an appropriate workup to exclude a neoplastic etiology, especially lymphomas.…”

Section: Discussionmentioning

confidence: 99%

Minimal Lymphatic Leakage in an Infant With Chylothorax Detected by Lymphoscintigraphy SPECT/CT

2014

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A 7-month-old girl with history of persistent left chylous pleural effusion was referred for lymphoscintigraphy. A previous chest computed tomography (CT) scan demonstrated a small to moderate-sized left pleural effusion but could not identify the lymphatic leakage site. Lymphoscintigraphy using filtered 99m Tc sulfur colloid showed minimal focal activity in the lower chest. A correlative single-photon emission computed tomography (SPECT)/CT localized this activity to distal paraesophageal region, being highly suggestive of the site of lymphatic leakage. Subsequent lymphangiography confirmed these findings, revealing an abnormal lymphatic branch at the level of T10 and T11 vertebrae with retrocrural extravasation toward the left hemithorax. Thoracic duct embolization was accomplished at and proximal to the site of chyle leak using a platinum coil and n-Butyl cyanoacrylate glue. The patient was followed up for .24 months and demonstrated no recurrence of pleural effusion. No ascites or other complications related to the procedure were noted. The case demonstrates that 99m Tc sulfur colloid lymphoscintigraphy SPECT/CT can be a useful modality for detecting the chyle leakage site in children with chylothorax even when the amount of leakage is minimal.

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“…51 In children, the reported incidence of chylothorax after cardiothoracic surgery is between 0.85% and 6.6%. 39,[52][53][54] Another traumatic cause of chylothorax is laceration of the thoracic duct during catheterization of the subclavian vein. 55,56 Noniatrogenic trauma can lead to the development of chylothorax.…”

Section: Causes Of Chylothoraxmentioning

confidence: 99%

“…2 Nonoperative management of chylothorax in children is successful in .80% of reported cases, including those patients with chylothorax after cardiothoracic surgery. 5,39,[52][53][54]106,107 To reduce the flow of chyle through the thoracic duct while waiting for spontaneous healing to occur, a fat-free diet with the addition of medium-chain triglycerides is instituted. Medium-chain triglycerides with saturated fatty acids of 8 to 12 carbon chain lengths are absorbed directly into the portal venous system, bypassing lymphatic drainage.…”

Section: Medical Management Of Chylothoraxmentioning

confidence: 99%

“…2 It occurs as a postoperative complication after various surgeries involving structures in the neck and thorax. [39][40][41][42][43][44] Other surgeries that can be complicated by chylothorax in children include those for treatment of scoliosis, [45][46][47][48] vascular rings, 49,50 and diaphragmatic hernia. 51 In children, the reported incidence of chylothorax after cardiothoracic surgery is between 0.85% and 6.6%.…”

Section: Causes Of Chylothoraxmentioning

confidence: 99%

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Chylothorax in Infants and Children

2014

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Chylothorax, the accumulation of chyle in the pleural space, is a relatively rare cause of pleural effusion in children. It can cause significant respiratory morbidity, as well as lead to malnutrition and immunodeficiency. Thus, a chylothorax requires timely diagnosis and treatment. This review will first discuss the anatomy and physiology of the lymphatic system and discuss various causes that can lead to development of a chylothorax in infants and children. Then, methods of diagnosis and treatment will be reviewed. Finally, complications of chylothorax will be reviewed. Pediatrics 2014;133:722-733

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Chylothorax in Children After Congenital Heart Surgery

Cited by 110 publications

References 35 publications

Chylothorax following pediatric cardiac surgery

Chylothorax following pediatric cardiac surgery

Minimal Lymphatic Leakage in an Infant With Chylothorax Detected by Lymphoscintigraphy SPECT/CT

Chylothorax in Infants and Children

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