Isolated chylopericardium after cardiac operations

Quilopericárdio isolado após cirurgia cardíaca

“…The accumulation of chylous fluid in the pericardial space was first described by Hasebrock in 1888 1 . In 1935, Yater, reviewing 100 cases of nontraumatic chylothorax, found 3 cases of chylopericardium 2 .…”

“…Chylopericardium has been estimated to represent 0.0004 to 0.15% of the complications of cardiac surgery 1,4 . By 1985, 13 cases had been reported since the first communication by Thomas and McGoon, with a mortality rate of 15.4%, and only 1 case occurring after aortic valve replacement.…”

“…The treatment may be surgical or conservative, depending on the volume and duration of the effusion. The conservative treatment consists of pericardial drainage associated with a medium-chaintriglyceride-enriched diet (MCT), and the surgical treatment consists of ligature of the thoracic duct through surgical exploration or thoracoscopy 5 and partial pericardiectomy 1 .…”

“…We report the case of a 24-year-old female patient refered to the Instituto de Cardiologia of the Rio Grande do Sul of the Fundação Universitária de Cardiologia of the Rio Grande do Sul in October 2001 after drainage of an intracerebral hematoma. The patient cardial space may result from one of the following: a direct lymphopericardial communication in the presence of fistulas; reflux of chyle due to lymphatic hypertension, causing loss of valvular function with failure in establishing collateral lymphatic drainage; or secondary to an increase in the permeability of the walls of the lymphatic vessels 1,8,10 .…”

“…The second, more common (69.2%) and later (mean of 25 days), manifests, as in our patient, as cardiac tamponade after a subclinical period of accumulation of chyle in the pericardium. Dyspnea, cyanosis, hypophonesis of the cardiac sounds, painful hepatomegaly, and severe edema in lower limbs characterize the syndrome of diastolic restriction 1,4,11 .…”