Massive chylopericardium after coronary artery bypass surgery

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.