Chylothorax as a complication of harvesting the left internal thoracic artery in coronary artery bypass surgery

Abstract

A patient is described with chylothorax after harvesting the left internal thoracic artery for coronary artery bypass surgery. Conservative treatment with a medium chain triglycerides diet and tube thoracostomy was not only unsuccessful, but also resulted in the complications of malnutrition and empyema. We recommend early surgical treatment of chylothorax after coronary bypass surgery with the use of an internal thoracic artery.

Idiopathic Primary Chylopericardium with Associated Chylothorax Following Coronary Artery Surgery—Successful Conservative Treatment

“…Chylopericardium is a rare complication following cardiac surgery. The incidence of combined chylopericardium and chylothorax is less than 0.25% and is mainly attributed to lymphatic injury to the thymus or anterior mediastinum, 1,2 thoracic duct injury during LIMA harvest 3,4 or extensive posterior pericardial dissection with possible interruption of major cardiac lymph channels. Other causes include inadvertent injury to the thoracic duct during encircling of the major vessels with surgical tapes because of its variable anatomy.…”

Chylothorax after coronary artery bypass surgery. Report of a case and review of the literature

“…In case the drainage persists beyond this, invasive strategy should be followed [7]. Some of the disadvantages of conservative management are deterioration in nutritional status and vulnerability to infections because of depletion of lymphocytes.…”

“…Invasive options are VATS, thoracotomy, median sternotomy. Most authors agree suggest that surgery should not be delayed for more than 1e2 weeks or the output remains more than 1000 ml/day [7,27]. Historically, lymphangiography and high fat content food has been administered before the invasive procedure to localize the leaking site.…”

“…But high fat content food has been shown to be preferable because the ducts damaged mostly in CABG are small in size [33]. Various strategies during invasive management are duct ligation, pleural flap cover, biological sealants and suturing of the leaking area [7]. If a delayed diagnosis is made, lavage and pleurodesis should be done through VATS because adhesions in the area of thoracic duct following surgery will make dissection in this area very difficult and dangerous [34].…”

Pleuroperitoneal Shunt for Chylothorax and Chylopericardium in Lung Cancer: A Case Report

“…1,2) We encountered a patient suffering from chylothorax and simultaneous chylopericardium due to disturbance of the thoracic ductal flow caused by metastasis of lung cancer to mediastinal lymph nodes. Conservative treatment for chylothorax, such as thoracic tube drainage, repeated pleurodesis, and intravenous hyperalimentation with fasting, was unsuccessful.…”