Use of Monogen for pediatric postoperative chylothorax

Cormack, Barbara; Wilson, Nigel; Finucane, Kirsten; West, Teena

doi:10.1016/s0003-4975(03)01189-5

Cited by 71 publications

(56 citation statements)

References 12 publications

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“…The management of fluid and electrolyte disturbances in these small infants with such losses is quite difficult. (3)(4)(5)(6)(7)(8)23) Somatostatin and its analogue, long periods of clinical treatment in our study, none of the patients developed pleural infection. In chylothorax, the most difficult task is the closure of the thoracic duct lymph fistula.…”

Section: Discussionmentioning

confidence: 47%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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Objective: To evaluate the use of video-assisted thoracoscopy in the surgical treatment of chylothorax developed after the surgical correction of congenital heart disease in children. Methods: We reviewed the medical charts of 3,092 children who underwent surgery for congenital heart disease between February of 2002 and February of 2007 at the Heart Institute of the University of São Paulo School of Medicine Hospital das Clínicas, in São Paulo, Brazil. Results: Of the 3,092 children, 64 (2.2%) presented with chylothorax as a postoperative complication. In 50 (78.1%) of those patients, the clinical management was successful, whereas it failed in 14 (21.9%), all of whom were then submitted to thoracic duct ligation by video-assisted thoracoscopy. The thoracic duct ligation was successful in 12 patients (86%) but failed in 2. In the postoperative period, additional clinical measures, such as a low-fat diet and parenteral nutrition, were required in order to resolve those 2 cases. There was no surgical morbidity or mortality. Of the 14 patients who underwent thoracic duct ligation, 5 (35%) died due to cardiac or infectious complications. Conclusions: Video-assisted thoracic duct ligation can be safely performed in patients with severe heart disease, and the outcomes are favorable.Keywords: Chylothorax; Heart defects, congenital; Thoracic duct. ResumoObjetivo: Avaliar o uso de videotoracoscopia no tratamento cirúrgico do quilotórax após cirurgia para correção de cardiopatias congênitas em crianças. Métodos: Revisamos os prontuários médicos de 3.092 crianças operadas para a correção de cardiopatias congênitas no Instituto do Coração/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP) entre fevereiro de 2002 e fevereiro de 2007. Resultados: Das 3.092 crianças, 64 (2,2%) apresentaram quilotórax como complicação pós-operatória. Em 50 (78,1%) dessas, o tratamento clínico foi bem-sucedido, enquanto esse falhou em 14 (21,9%), as quais foram submetidas à ligação do ducto torácico por videotoracoscopia. A ligação do ducto torácico obteve sucesso em 12 pacientes (86%) e falhou em 2 casos, os quais foram resolvidos com medidas clínicas adicionais, como dieta pobre em gorduras e nutrição parenteral. Não houve morbidade ou mortalidade relacionada à operação. Dos 14 pacientes, 5 (35%) faleceram em decorrência de complicações cardíacas ou infecciosas. Conclusões: A ligadura videoassistida do ducto torácico pode ser realizada com segurança em pacientes gravemente enfermos e com doença cardíaca grave, com resultados favoráveis.

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Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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“…Se debe aportar una dieta pobre en grasa, con restricción de ácidos grasos de cadena larga, suplementada con triglicéridos de cadena mediana, los que se absorben directamente a la circulación portal, evitando el CT, disminuyendo de esta manera la acumulación de quilo en el espacio pleural 10,11 . Debido a que el recién nacido requiere ácidos grasos esenciales de cadena larga se ha usado con éxito Monogen o Portagen 12 , las cuales aportan 86% de ácidos grasos de cadena mediana y una cantidad adecuada de ácidos grasos de cadena larga esenciales (350 mg% de ácido linoleíco y 1,88 mg% de L-carnitina). Si el paciente presenta desnutrición y/o el drenaje pleural es elevado y persistente el niño debe permanecer en ayunas y se le debe administrar nutrición parenteral total, con el fin de disminuir al máximo el flujo linfático intestinal y por ende a través del CT 13 .…”

Section: Discussionunclassified

Caso Clínico Radiológico para diagnóstico

M¹,

O²,

R³

et al. 2007

Rev. chil. pediatr.

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“…Medium-chain triglyceride formulas do not contain essential fatty acids, so those will need to be supplemented if these formulas are used for .3 weeks. 108 There is a report of the successful use of an enteral formula containing long-chain triglycerides, 109 and a report of the combined use of low-fat breast milk and octreotide, to treat postoperative chylothorax. 110 A more aggressive option is complete enteric rest by using total parenteral nutrition.…”

Section: Figurementioning

confidence: 99%

Chylothorax in Infants and Children

2014

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Chylothorax, the accumulation of chyle in the pleural space, is a relatively rare cause of pleural effusion in children. It can cause significant respiratory morbidity, as well as lead to malnutrition and immunodeficiency. Thus, a chylothorax requires timely diagnosis and treatment. This review will first discuss the anatomy and physiology of the lymphatic system and discuss various causes that can lead to development of a chylothorax in infants and children. Then, methods of diagnosis and treatment will be reviewed. Finally, complications of chylothorax will be reviewed. Pediatrics 2014;133:722-733

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Use of Monogen for pediatric postoperative chylothorax

Cited by 71 publications

References 12 publications

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

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

Caso Clínico Radiológico para diagnóstico

Chylothorax in Infants and Children

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