Chylothorax after cardiovascular surgery in children
Obo, H.; Ohshima, Y.; Ohhashi, H.; Hosokawa, Y.; Tachibana, H.; Yamaguchi, M.
Nihon Kyobu Geka Gakkai 35(8): 1151-1157
1987
ISSN/ISBN: 0369-4739 PMID: 3668342 Document Number: 286896
This paper presents a review of our experience of 14 cases of chylothorax occurred as a complication of intrathoracic operation for congenital heart disease (6 cases with PDA ligation or division, 3 with left Blalock-Taussig's procedure, one each with right Blalock-Taussig's procedure subclabian flap aortoplasty, aorta-to-left pulmonary artery shunt, pulmonary valvotomy, and total correction of tetralogy of Fallot) during the past 11 years. Ages ranged from 7 days to 6 years (average 3.1 years). Three cases were treated surgically and the others by conservative management. Conservative therapy consisted of thoracocentesis, tube thoracostomy, low-fat diet administration of medium-chain triglyceride. Operative procedure was only a ligation for leaking lymphatic duct by thoracotomy. In 2 of the operated cases, thoracotomy were carried out soon after the initial operation or insertion of chest tube because of enormous drainage (2 to 3 ml/kg/hr), and in the remaining patient, surgical intervention was decided after 5 days conservative therapy as there was no sign of decrease of drainage. In the majority of cases treated conservatively (initial drainage volume less than 2 ml/kg/hr), the amount of drainage decreased to less than 0.1 ml/kg/hr within 4 days. Drop of serum total protein (range 0.2 to 2.0 g/dl, average 1.3 g/dl) was observed in 70% of the cases during the therapy. It is concluded that the conservative therapy is indispensable in all cases, but an early surgical intervention is indicated when the chyle loss is more than 2 ml/kg/hr or the conservative therapy is ineffective for more than 4 days.