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Chylothorax: a rare postoperative complication in paediatric cardiac surgery patients - a 15-year retrospective study

Bshara Sleem1, Jad Abdul Khalek1, Adham Makarem2

  • 1Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

Cardiology in the Young
|March 13, 2025
PubMed

Insights

Postoperative chylothorax in children undergoing heart surgery is rare but manageable. Conservative and medical treatments, like octreotide, were effective in most cases, with no reported deaths.

Area of Science:

  • Pediatric Cardiology
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Chylothorax, the accumulation of chyle in the pleural space, is a recognized postoperative complication following congenital heart disease (CHD) surgery.
  • Effective diagnosis and management of pediatric chylothorax remain challenging, impacting patient recovery and hospital stay.

Purpose of the Study:

  • To investigate the incidence, causes, treatment strategies, and outcomes of postoperative chylothorax in pediatric patients undergoing cardiac surgery.
  • To analyze the clinical features and diagnostic approaches for chylothorax in this specific patient population.

Main Methods:

  • A 15-year retrospective review of medical records for pediatric patients who underwent cardiothoracic surgery.
  • Inclusion criteria focused on patients diagnosed with postoperative chylothorax, with data collected on demographics, surgical procedures, diagnosis, treatment, and outcomes.
  • Descriptive statistics were used to analyze the collected data.

Main Results:

  • Nineteen cases of postoperative chylothorax were identified among 2,997 pediatric cardiothoracic surgeries (0.63% incidence).
  • Female patients (63.2%) with a median age of 9 months were predominantly affected, with Glenn, Fontan, and Blalock-Taussig shunt surgeries being common triggers.
  • Single ventricle physiology (58%) was the most frequent CHD; diagnosis relied on clinical signs, imaging, and pleural fluid triglyceride levels. Conservative and medical management, including octreotide, were successful in all cases without mortality.

Conclusions:

  • Postoperative chylothorax in pediatric cardiac surgery patients, though uncommon, has identifiable risk factors and is effectively managed with current strategies.
  • Conservative and medical therapies demonstrate significant efficacy, suggesting a potential for standardized treatment protocols.
  • Further research with larger cohorts is warranted to refine diagnostic criteria and optimize management protocols for improved patient outcomes.

Keywords:
Chylothoraxcardiac surgerycomplicationscongenital heart diseasecongenital heart surgery

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