Postoperative Chylothorax After Cardiothoracic Surgery in Children

Chan, Emily H.; Russell, Jennifer; Williams, William G.; Arsdell, Glen S. Van; Coles, John G.; McCrindle, Brian W.

doi:10.1016/j.athoracsur.2005.04.048

Cited by 173 publications

(263 citation statements)

References 19 publications

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“…Allen et al [9] reported an incidence rate of 1% in their study in 1979 and 1987 while the latest reported incidence rates were 3.5% by Chan et al [3] and 5% by Ismail et al [10] The higher rates were likely due to the increased complexity of the patients along with the number of singleventricle repairs and redo surgeries. [3] The incidence of chylothorax in our study population was 3.1%, which Five of these patients had HLHS, and four underwent redo surgeries. Chan et al [3] reported that chylothorax is mostly seen in heart transplantation operations and patients with Fontan circulation.…”

Section: Discussionmentioning

confidence: 89%

“…Moreover, 18 patients underwent additional testing of the fluid cell counts, and this showed that nine (50%) had a total white blood cell (WBC) count of over 1,000 cells/mm 3 . In addition, the percentage of lymphocytes was more than 80% in 13 of the patients (72%), and two had at least one of the three fluid abnormalities.…”

Section: Resultsmentioning

confidence: 99%

“…[3] The incidence of chylothorax in our study population was 3.1%, which Five of these patients had HLHS, and four underwent redo surgeries. Chan et al [3] reported that chylothorax is mostly seen in heart transplantation operations and patients with Fontan circulation. In our study, the single-ventricle surgeries were most frequently complicated by chylothorax (n=11, 31%) followed by arch repairs (n=9, 25%); VSD repairs (n=2, 6%), ASD repairs (n=4, 11%), arterial switch repairs (n=3, 8%), and other types of repair (n=2, 6%).…”

Section: Discussionmentioning

confidence: 99%

“…Prolonged chylothorax places patients at risk for malnutrition, poor wound healing, infections, fluid imbalance, electrolyte abnormalities, prolonged mechanical ventilation and device utilization, and longer stays in the hospital and intensive care unit (ICU). [3,4] The first step in chylothorax treatment is the drainage of the pleural fluid to decrease the flow of the lymphatic fluid from the ductus thoracicus. This is followed by a low-fat or fat-free diet or the replacement of enteral food with liquid intake [nil per os (NPO)] or the use of total parenteral nutrition (TPN) including intravenous lipids.…”

mentioning

confidence: 99%

“…This is followed by a low-fat or fat-free diet or the replacement of enteral food with liquid intake [nil per os (NPO)] or the use of total parenteral nutrition (TPN) including intravenous lipids. [1][2][3] Pharmacotherapy with the somatostatin analogue octreotide has also been proposed to decrease the blood flow to the hepatic, portal, and splanchnic circulations, resulting in a decrease in the lymphatic flow through the ductus thoracicus. [5] If medical therapy fails, surgical intervention should be considered, with thoracic duct ligation, pleurodesis, and pleural peritoneal shunting being appropriate options for persistent chylothorax.…”

mentioning

confidence: 99%

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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: 89%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Chylothorax following pediatric cardiac surgery

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The Nurse Practitioner's Role in Patient Management

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Magnetic Resonance Lymphangiography of the Central Lymphatic System: Technique and Clinical Applications

Pabon‐Ramos

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et al. 2020

Magnetic Resonance Imaging

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Magnetic resonance lymphangiography (MRL) is a noninvasive imaging technique that can be used in the management of lymphatic disorders to delineate the central lymphatic system for treatment planning. This article reviews the MRL technique, its advantages, limitations, indications, and impact on patient management.Level of Evidence 5Technical Efficacy Stage 3J. MAGN. RESON. IMAGING 2021;53:374–380.

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Postoperative Chylothorax After Cardiothoracic Surgery in Children

Cited by 173 publications

References 19 publications

Chylothorax following pediatric cardiac surgery

Chylothorax following pediatric cardiac surgery

The Nurse Practitioner's Role in Patient Management

Magnetic Resonance Lymphangiography of the Central Lymphatic System: Technique and Clinical Applications

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