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Published on: March 18, 2019
Isolated chylopericardium after cardiac operations
Insights
Chylopericardium, milky fluid in the pericardial sac after heart surgery, can be identified by milky mediastinal drainage. Management depends on drainage volume, ranging from diet changes to thoracic duct ligation.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Gastroenterology
Background:
- Chylopericardium is a rare complication following cardiac operations.
- It involves the accumulation of chyle, a lipid-rich fluid, within the pericardial space.
- Diagnosis can be challenging due to its infrequent occurrence.
Observation:
- Four case histories of chylopericardium post-cardiac surgery are presented.
- Key diagnostic feature is postprandial milky mediastinal drainage, confirmed by Sudan III staining for fat.
- Drainage originates from operative injury to the thoracic duct or its tributaries, or venous thrombosis obstructing thoracic duct flow.
Findings:
- The study identifies operative injury to the thoracic duct or related venous structures as primary causes.
- Milky mediastinal fluid, positive for fat, is a reliable indicator of chylopericardium.
- Management strategies are tailored to drainage volume and duration.
Implications:
- Early recognition and diagnosis are crucial for effective patient management.
- Conservative treatment involves pericardial drainage and a medium-chain triglyceride diet.
- Surgical intervention, such as thoracic duct ligation, may be necessary for persistent or high-volume drainage.
Abstract:
Case histories are reported of four patients having chylopericardium following cardiac operations. This entity can be recognized by noting the presence of postprandial milky mediastinal drainage that stains positive for fat with Sudan III. Chylopericardium is caused by operative injury to the thoracic duct, by operative injury to tributaries of the thoracic duct, or by thrombosis at the confluence of the left subclavian and jugular veins with subsequent obstruction of thoracic duct drainage. Appropriate management, which may be either conservative or operative, depends upon the volume and duration of drainage. The conservative approach entails adequate pericardial drainage and institution of a medium-chain triglyceride diet; operative therapy entails ligation of the thoracic duct low in the posterior mediastinum.
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