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Management of chylopericardium
B B Chan1, M C Murphy, B M Rodgers
1Department of Surgery, Children's Medical Center, University of Virginia Health Sciences Center, Charlottesville 22908.
Journal of Pediatric Surgery
|November 1, 1990
Summary
Pericardial-peritoneal shunting effectively treats chylopericardium in children, offering a less invasive alternative to surgery. This method resolved chylopericardium in all studied cases without recurrence.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Medical Devices
Background:
- Chylopericardium is a rare condition with diverse etiologies including congenital factors, surgical trauma, and mediastinal masses.
- Current treatments range from conservative measures like dietary modifications and pericardiocentesis to invasive surgical interventions such as pericardiectomy and thoracic duct ligation.
Observation:
- Four pediatric patients with chylopericardium (three from mediastinal lymphangioma-hygroma, one post-cardiac surgery) were treated between 1986 and 1989.
- Initial treatments included pericardiocentesis and tube drainage, with limited success in most cases.
- One infant with a mediastinal cystic hygroma responded to tube drainage after resection.
Findings:
- Pericardial-peritoneal shunting using Denver shunts was employed in three patients who did not respond to less invasive methods.
- Shunt placement resulted in complete resolution of chylopericardium without recurrence in all treated patients.
- Drainage durations varied, with one shunt removed after 14 days and another exteriorized for 8 weeks.
Implications:
- Pericardial-peritoneal shunting presents a safe and effective alternative for managing pediatric chylopericardium.
- This approach may avoid the need for more extensive surgical procedures like thoracotomy.
- The study highlights the utility of shunting in refractory cases of chylopericardium across various underlying causes.