Chylothorax after median sternotomy for intrapericardial cardiac surgery

Chylothorax following cardiovascular surgery occurs with an incidence of 0.25 to 0.5 per cent. We are aware of only 5 reported cases in the literature following intrapericardial procedures. This report includes the forth documented case following ventricular septal defect closure and the first 4 reported cases following median sternotomy for intrapericardial acquired cardiac disease. The fistula in all cases occurred in the anterior mediastinum in the region of the thymic tissue. This problem can be prevented by surgical ligation of the thymic vascular structures at the time of dissection rather than the use of electrocautery. The treatment recommended is a 2 week trial of conservative therapy with a diet of medium-chain triglycerides and closed-chest suction. If this fails, surgical division of the fistula is recommended.