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Massive chylopericardium after coronary artery bypass surgery
R V Pellegrini1, D J Travers, A G Marrangoni
1Department of Thoracic Cardiovascular Surgery and the Surgical Research Laboratories, Mercy Hospital, Pittsburgh, Pennsylvania 15219, USA.
Texas Heart Institute Journal
|September 1, 1987
Summary
Massive isolated chylopericardium, a rare complication after coronary artery bypass surgery, can occur due to thoracic duct trauma. Prompt drainage typically resolves this condition, though thoracic duct ligation may be needed if drainage persists.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Complications
Background:
- Massive isolated chylopericardium is an infrequent complication following cardiac surgical procedures.
- Coronary artery bypass grafting (CABG) is a common cardiac surgery where this complication can arise.
- The use of the left internal mammary artery (LIMA) graft in CABG has been associated with specific anatomical considerations.
Purpose of the Study:
- To report a rare case of massive isolated chylopericardium after coronary artery bypass surgery.
- To elucidate the mechanism of injury leading to chylopericardium in this specific context.
- To discuss the management and potential interventions for persistent chylopericardium.
Main Methods:
- Case report detailing a patient who developed massive isolated chylopericardium post-CABG.
- Description of the surgical technique involving left internal mammary artery revascularization.
- Documentation of the diagnostic process and therapeutic interventions, including chest tube drainage.
Main Results:
- Massive isolated chylopericardium developed postoperatively in a patient undergoing CABG with LIMA graft.
- The chylopericardium was attributed to direct trauma to the thoracic duct during LIMA mobilization.
- The condition resolved successfully with adequate chest tube drainage.
Conclusions:
- Massive isolated chylopericardium is a rare but significant complication of CABG, particularly when using LIMA grafts.
- Thoracic duct injury during LIMA harvesting is a plausible cause of chylopericardium.
- While drainage is often effective, thoracic duct ligation may be required for refractory cases.