Prevalence and Clinical Course of Pleural Effusions at 30 Days after Coronary Artery and Cardiac Surgery

Abstract

The present prospective study was designed to determine the prevalence of pleural effusion at approximately 28 days after cardiac surgery and their subsequent course. This consecutive case study included 389 patients; 312 had only coronary artery bypass graft surgery (CABG) surgery, 37 had both valve and CABG surgery, and 40 had only valve surgery. Chest radiographs were obtained approximately 28 days postoperatively. Patients were subsequently contacted by telephone 3, 6, and 12 months postoperatively and questioned about the presence of fluid in their chest and related symptoms. The prevalence of pleural effusions in the patients undergoing only CABG surgery (63%) or CABG surgery plus valve surgery (62%) was significantly (p = 0.05) higher than that in the patients undergoing valve surgery only (45%). The prevalence of effusions occupying more than 25% of the hemithorax was 9.7%. The primary symptom associated with these larger effusions was dyspnea. Chest pain and fever were uncommon. Over the 12-month follow-up, the effusions tended to resolve. In conclusion, the prevalence of pleural effusions occupying more than 25% of the hemithorax is approximately 10%, 28 days postoperatively. These larger pleural effusions produce dyspnea but not chest pain or fever, and most of the effusions disappear gradually over the subsequent months.

Early Chylothorax After Coronary Artery Bypass Grafting

“…The Red blood cells content will be low and theirs range could be between 20 -50 cells per mm 2 . The initial treatment of chylothorax is conservative approach, to minimize chyle formation, to prevent the immune deficiency, and to maintain adequate drainage as well as to replace a high-fat diet with high content protein diet which is absorbed directly in the portal system without passing through the thoracic duct [9][10][11][12]. If the drainage remains high in spite of therapy, total parenteral nutrition must be indicated.…”

The management of benign non-infective pleural effusions

“…Of those patients with a persistent pleural effusion after coronary artery bypass grafting, many only require a single thoracentesis with more long-term treatment rarely required [28]. Pleural effusions also occur as a manifestation of post-cardiac injury (or Dressler's) syndrome [29].…”

Common iatrogenic pleural complications

“…Post-coronary artery bypass grafting (CABG) pleural effusion is a common complication and can occur early (< 30 days after the surgery) or late [64]. The prevalence is highest in the immediate post-operative period, but a significant effusion may still be present in around 10% of patients after 1 month [65]. Often in the case of early post-CABG pleural effusion, symptoms are minimal and most settle without treatment, but if they persist patients may require repeated therapeutic aspirations for symptomatic relief.…”