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Chylothorax after coronary artery bypass grafting using the right internal thoracic artery

Koichi Deguchi1, Takashi Yamauchi, Shusaku Maeda

  • 1Department of Cardiovascular Surgery, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan.

General Thoracic and Cardiovascular Surgery
|August 8, 2013
PubMed

Insights

Chylothorax, a rare complication after coronary artery bypass grafting (CABG), occurred due to thoracic duct injury during internal thoracic artery (ITA) harvesting. Surgical repair was successful after conservative treatment failed.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Surgical Complications

Background:

  • Chylothorax is a rare but serious complication following coronary artery bypass grafting (CABG).
  • It often results from injury to the thoracic duct during internal thoracic artery (ITA) harvesting.
  • Anatomical variations in the thoracic duct system increase the risk of injury.

Observation:

  • A 78-year-old female patient presented with a large-volume milky pleural effusion three days post-CABG.
  • Conservative management, including nutritional support, was unsuccessful.
  • Diagnosis was confirmed via biochemical analysis of the pleural fluid.

Findings:

  • Surgical exploration revealed disruption of the thoracic duct or a tributary near the right ITA.
  • The injury was successfully repaired using interrupted sutures.
  • This case highlights the risk associated with harvesting either the left or right ITA.

Implications:

  • Thoracic duct injury during ITA harvesting is a significant risk factor for chylothorax post-CABG.
  • Early diagnosis and surgical intervention are crucial for managing refractory chylothorax.
  • Awareness of thoracic duct anatomy is vital for cardiac surgeons to minimize this complication.

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