The Management of Chylothorax/Chylopericardium Following Pediatric Cardiac Surgery: A 10-Year Experience

Abstract

We reviewed the management of 25 cases of chylothorax/chylopericardium (CT/CP) in 24 patients (9 females, 15 male; 3 days to 11-years-old) following 1605 cardiothoracic procedures (incidence of 1.5%) between January 1984 and December 1993 at our institution. The surgical procedures preceding the occurrence of lymph leak included ligation of patent ductus arteriosus (6 patients), coarctation/double aortic arch repairs (3), complex intracardiac repairs (11), and systemic to pulmonary shunts (5). There were 3 CPs and 22 CTs. All of the patients were initially treated nonsurgically with diet modification using either total parenteral nutrition (TPN) or enteral low fat solid food or enteral elemental diet supplemented with intravenous lipid emulsion. Twenty-one cases (84%) responded to conservative therapy. Of those, 15 had TPN as the initial treatment; the average duration of lymph leak was 13.7 (range 7 to 30) days and the average maximal lymph leak was 39.4 (range 15 to 130) mL/kg per day. The other six cases had low-fat enteral diet as the initial treatment, four resolved completely. Two with high-central venous pressure had to be switched to TPN prior to complete resolution. The average duration of lymph leak in this subgroup was 30 (range 12 to 56) days with the average maximal lymph leak was 30.1 (range 8.5 to 59) mL/kg per day. Excluding these two cases, the average lymph leak of the rest of the group was very compatible to the TPN group of 15 days. Lymphocytopenia and hyponatremia were frequently seen during CT/CP (47.6% and 43%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

“…Stężenie cholesterolu w chłonce jest takie same jak we krwi lub większe. Nakłucie osierdzia rzadko przynosi efekty, a skuteczną terapię stanowią radykalna perikardiektomia i leczenie choroby podstawowej [215,216].…”

Videotoracoscopia como uma opção no tratamento cirúrgico do quilotórax após cirurgia cardíaca pediátrica

“…The reported incidence of postoperative chylothorax following congenital cardiac surgery ranges from 1.5% to 4.7%. (3)(4)(5) It is associated with extrapericardial procedures, such as patent ductus arteriosus closure, the Blalock-Taussig procedure, and correction of aortic coarctation. In such cases, chylothorax is due to direct trauma to the thoracic duct or its tributaries.…”

“…Such complications are poorly tolerated in small infants with severe heart disease and are associated with high mortality when left untreated. (3)(4)(5)(6)(7)(8) Patients usually remain asymptomatic, presenting with pronounced chylous effusion only after being started on a regular diet. The initial management consists of pleural drainage, allowing lung expansion, and dietary strategies to decrease lymphorrhea.…”

“…When such techniques are applied, thoracic duct ligation can be accomplished with less surgical trauma and fewer postoperative complications. (3,8,(17)(18)(19)(20) …”

Chylothorax in Infants and Children

“…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.…”