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Diaphragmatic fenestration for refractory chylothorax after congenital cardiac surgery in infants
T K Susheel Kumar1, Kaitlin Balduf2, Umar Boston1
1Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn.
Insights
Diaphragmatic fenestration effectively manages chylous pleural effusions in infants post-congenital heart surgery. This safe procedure resolves effusions, allowing patients to resume feeding quickly without recurrence.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Chylous pleural effusion post-congenital heart surgery leads to significant infant morbidity and mortality.
- Medical management often fails in these complex cases.
Purpose of the Study:
- To review the experience with diaphragmatic fenestration for refractory chylous pleural effusion in infants after congenital heart surgery.
Main Methods:
- Retrospective chart review of 8 patients undergoing 9 diaphragmatic fenestrations over 2 years.
- Analysis of patient demographics, procedure details, and outcomes.
Main Results:
- 9 procedures in 8 infants (median age 4.6 months) with failed medical management.
- Average chest tube removal at 4 days, extubation at 3 days.
- Successful feeding advancement within 12 days for most patients; no complications or recurrence at 19-month follow-up.
Conclusions:
- Diaphragmatic fenestration is a safe and effective treatment for persistent chylous effusions after congenital cardiac surgery.
- The procedure facilitates rapid recovery and resumption of feeding.
Objective:
Medically refractory chylous pleural effusion after congenital heart surgery is associated with significant morbidity and mortality, especially in infants. We reviewed our experience with diaphragmatic fenestration procedure in this group of patients.
Methods:
A retrospective chart review of all patients who had diaphragmatic fenestrations for chylous effusion at our institution over a 2-year period was performed.
Results:
A total of 9 diaphragmatic fenestration procedures were performed in 8 patients who had failed medical management of chylous pleural effusions. All procedures except 1 were performed on the right side. The median age at time of procedure was 4.6 months (range, 3 weeks to 14 months). The average time between primary congenital cardiac surgery and fenestration was 26 days (range, 4-53 days). Three patients had single ventricle repair. Average time of chest tube removal after procedure was 4 days. Average time to extubation was 3 days. All patients but 1 were able to advance to full feedings without reaccumulation of chylous effusion within 12 days. No complications developed in the patients. Recurrent effusion over a median follow-up period of 19 months did not develop in the patients.
Conclusions:
Diaphragmatic fenestration is an effective and safe strategy for management of persistent chylous effusions after congenital cardiac surgery.
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Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...