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Etiology and management of chylothorax following pediatric heart surgery

Michael Milonakis1, Andrew C Chatzis, Nikolaos M Giannopoulos

  • 1Department of Pediatric and Congenital Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece. milonakis@ath.forthnet.gr

Journal of Cardiac Surgery
|July 9, 2009
PubMed

Insights

Conservative management effectively treats most cases of chylothorax following congenital heart surgery (CHD). Surgical pleurodesis is successful for refractory cases, ensuring positive outcomes for this rare complication.

Area of Science:

  • Pediatric Cardiac Surgery
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Chylothorax is a rare but challenging complication after congenital heart surgery (CHD).
  • This study reviews institutional experience managing postoperative chylothorax in pediatric patients.

Purpose of the Study:

  • To evaluate the management strategies and outcomes of chylothorax in pediatric patients undergoing congenital heart defect repair.

Main Methods:

  • A retrospective review of 1341 pediatric patients undergoing CHD surgery between 1997 and 2006.
  • 18 patients (1.3%) developed postoperative chylothorax and were treated with drainage, controlled nutrition, and somatostatin (adjunctively in 6 patients).
  • Surgical intervention was reserved for persistent cases unresponsive to maximal conservative therapy.

Main Results:

  • No deaths occurred among the 18 patients.
  • Conservative therapy resolved chylothorax in 15 patients (83.3%).
  • Three patients required thoracotomy with pleurodesis for persistent lymph leak, with two previously failing chemical pleurodesis.

Conclusions:

  • Postoperative chylothorax is infrequent after CHD surgery, even without elevated venous pressure.
  • Conservative management is effective for the majority of cases.
  • Surgical pleurodesis is a successful option for refractory chylothorax after congenital heart surgery.
Abstract

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