Related Experiment Video
Updated: Jun 9, 2025
Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
Treatment of concomitant persistent chylothorax and superior vena cava syndrome through innominate vein-right atrial
Emrah Şişli1, Arzu Funda Tarhan1, Eylem Kıral2
1Section of Paediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Osmangazi University Faculty of Medicine, Eskişehir, Türkiye.
Insights
A novel surgical approach successfully treated persistent chylothorax in a pediatric patient with superior vena cava syndrome. This bypass surgery offered a life-saving solution without cardiopulmonary bypass, leading to rapid recovery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Thoracic Surgery
- Vascular Surgery
Background:
- Persistent chylothorax poses significant challenges in pediatric care.
- Superior vena cava syndrome (SVCS) and associated thrombosis complicate treatment.
- Previous conservative management (dietary changes, somatostatin) failed in this case.
Purpose of the Study:
- To describe a successful surgical intervention for persistent chylothorax in a pediatric patient with complex comorbidities.
- To present an alternative to cardiopulmonary bypass for treating superior vena cava syndrome-induced chylothorax.
Main Methods:
- A 1-year-old boy with SVCS, persistent chylothorax, and multiple comorbidities underwent surgical treatment.
- An innominate vein-to-right atrial bypass using a 6-mm Dacron graft was performed.
- The procedure was successfully completed without the need for cardiopulmonary bypass.
Main Results:
- The surgery resulted in a significant reduction of chylous pleural effusion.
- The patient experienced accelerated recovery post-operatively.
- This indicates the efficacy of the bypass graft in managing thoracic duct obstruction.
Conclusions:
- Surgical bypass of the superior vena cava is a viable and effective treatment for persistent chylothorax in pediatric patients with complex venous obstruction.
- This approach offers a successful alternative to cardiopulmonary bypass, especially when conservative measures fail.
Abstract:
Persistent chylothorax is a major challenge in paediatric patients. We present a case of a 6.5 kg, 1-year-old boy with superior vena cava syndrome and persistent chylothorax who underwent successful surgery without cardiopulmonary bypass. His medical history included multiple comorbidities such as myeloproliferative disease, short bowel syndrome and central vein catheterizations. The patient also had innominate vein thrombosis, progressing to superior vena cava, and was on anticoagulants. Despite dietary changes and somatostatin, his high-output chylous pleural effusion persisted. He was treated with innominate vein-to-right atrial bypass using a 6-mm Dacron graft. Postoperatively, there was a significant reduction in effusion and accelerated recovery. Somatostatin failure was likely due to mechanical obstruction of the thoracic duct.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:19Veins of Thorax
The azygos vein, positioned just right of the midline and anterior to the vertebral column, begins at the junction of the right ascending lumbar and subcostal veins, terminating in the superior vena cava. This vein drains blood from the right side of the thoracic wall, thoracic viscera, and posterior abdominal wall.
The...
01:11Overview of Systemic Veins
The coronary sinus, the heart's principal vein, resides in the coronary sulcus on the heart's posterior aspect. This broad venous channel receives nearly all venous blood from the myocardium, the heart muscle. It is fed by three primary veins: the great cardiac vein, the...
01:26Varicose Veins II: Diagnostic Studies and Interprofessional Care
01:18Veins of the Abdomen and Pelvis
The inferior vena cava is fed by numerous smaller veins. The lumbar veins, for instance, drain the posterior abdominal wall, emptying both directly into the inferior vena cava and into the...
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...