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Pleuroperitoneal shunts for refractory chylothorax after operation for congenital heart disease
K S Rheuban1, I L Kron, M A Carpenter
1Department of Pediatrics, University of Virginia Health Sciences Center, Charlottesville 22908.
Insights
Pleuroperitoneal shunting effectively treated symptomatic chylothorax in children post-congenital heart surgery when traditional methods failed. This intervention showed a 90% success rate, offering a safe option for managing this complication.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Critical Care Medicine
Background:
- Symptomatic chylothorax is a serious complication following operations for congenital heart disease.
- Traditional medical therapies (thoracentesis, tube thoracostomy, low-fat diet) are often ineffective in resolving post-operative chylothorax.
- Persistent chylothorax can lead to significant morbidity in pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of pleuroperitoneal shunting for treating symptomatic chylothorax in children after congenital heart surgery.
- To assess the impact of elevated right atrial pressure on the success of pleuroperitoneal shunting.
Main Methods:
- Retrospective review of 12 pediatric patients with symptomatic chylothorax post-congenital heart surgery between 1980 and 1990.
- Patients who failed traditional medical therapy underwent placement of a pleuroperitoneal shunt.
- Cardiac catheterization was performed in 5 patients to measure right atrial pressure prior to shunting.
Main Results:
- 10 of 12 patients failed traditional medical therapy.
- Pleuroperitoneal shunting resulted in complete resolution of chylothorax in 9 out of 10 patients (90% success rate).
- The shunt was effective in patients with moderately elevated right atrial pressure (10-16 mm Hg) but not with a pressure of 25 mm Hg.
Conclusions:
- Pleuroperitoneal shunting is a safe and effective treatment for refractory symptomatic chylothorax after congenital heart surgery in children.
- The procedure demonstrates high success rates even with moderate elevations in right atrial pressure.
- Careful consideration of right atrial pressure is warranted when planning pleuroperitoneal shunting.
Abstract:
Between 1980 and 1990, 10 of 12 children with a symptomatic chylothorax after operation for congenital heart disease failed to respond to traditional medical therapy (thoracentesis, tube thoracostomy, low-fat diet). All 10 patients underwent placement of a pleuroperitoneal shunt, with complete resolution of the chylothorax in 9 patients (90%). Cardiac catheterization, performed before placement of the pleuroperitoneal shunt in 5 patients, demonstrated elevated right atrial pressure in all patients (range, 10 to 25 mm Hg). The pleuroperitoneal shunt functioned effectively in 4 patients with moderately elevated right atrial pressures (range, 10 to 16 mm Hg; median, 13.5 mm Hg) but not in 1 patient with a right atrial pressure of 25 mm Hg. Pleuroperitoneal shunting as treatment for chylothorax after operation for congenital heart disease is safe and effective, even in the face of moderate elevations in right atrial pressure.