Diaphragmatic fenestration for refractory chylothorax after congenital cardiac surgery in infants

Abstract

Diaphragmatic fenestration is an effective and safe strategy for management of persistent chylous effusions after congenital cardiac surgery.

Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report

“…Loss of lymphatic fluid rich in proteins, fats, and immunoglobulins results in dehydration, malnutrition, immunosuppression with increased preponderance to infections. 1,4,5 These, in addition to the prolonged hospital stay, result in increased cost of care.…”

“…The attendant pain and limitation in pulmonary function makes this option not optimal. 5 Durairaj et al, described successful diaphragmatic fenestration for persistent chylothorax using a polypropylene mesh in a 12-year-old patient after the Fontan operation. 10 Further case series by Talwar and colleagues and Kumar et al also documented successful treatment of chylothorax following cardiac surgery using polytetrafluoroethylene (Gore-Tex) patch.…”

“…10 Further case series by Talwar and colleagues and Kumar et al also documented successful treatment of chylothorax following cardiac surgery using polytetrafluoroethylene (Gore-Tex) patch. 5,9 Diaphragmatic fenestration has the advantage of reducing external loss of pleural fluid proteins and nutrient as this is absorbed in the peritoneal cavity. 10 Its efficacy in reducing the volume of daily pleural effluent as well as the number of days required for chest drainage has been demonstrated.…”

“…[1][2][3][4] This significant morbidity results from loss of fluid, proteins and immunoglobulins leading to respiratory compromise, malnutrition and immunosuppression with increasing susceptibility to sepsis with prolonged hospital stay. 1,4,5 Its incidence following cardiac surgery varies widely, mostly reported as 0.5% to 5% with some studies reporting much higher values. [1][2][3]5 Algorithms for the management of postoperative chylothorax currently offer a conservative approach to the care of patients in the early days following diagnosis.…”

“…1,4,5 Its incidence following cardiac surgery varies widely, mostly reported as 0.5% to 5% with some studies reporting much higher values. [1][2][3]5 Algorithms for the management of postoperative chylothorax currently offer a conservative approach to the care of patients in the early days following diagnosis. Methods employed include fasting, use of medium chain triglyceride/ low fat feeds, total parenteral nutrition, and octreotide therapy.…”