Chylothorax following pediatric cardiac surgery

Abstract

ÖZAmaç: Bu çalışmada şilotoraksın insidansı, tedavi protokolleri ve pediatrik kardiyovasküler cerrahi sonrası erken dönem bulgular üzerindeki etkisi değerlendirildi. Ça lış ma pla nı: Haziran 2011 -Haziran 2014 tarihleri arasında kliniğimizde kalp ameliyatı geçiren 1123 pediatrik hastanın kayıtları retrospektif olarak incelendi. Ameliyat sonrası şilotoraks gelişen 35 hasta (19 erkek, 16 kız; ortanca yaş 240 gün; dağılım 5 gün-15 yıl) çalışmaya dahil edildi. Bul gu lar: Şilotoraks gelişimi en sık tek ventrikül tamirlerinde saptandı (n=11, %31). Bunu aortik ark tamiri (n=9, %25), Fallot tetralojisi (n=4, %11) atriyoventriküler septal defekt tamirleri (n= 4, %11), arteriyel switch ameliyatları (n=3, %8), ventriküler septal defekt tamirleri (n=2, %6) ve diğer ameliyatlar (n=2, %6) izledi. Ortanca şilotoraks drenaj süresi dokuz gün (dağılım 2-44 gün) idi. Beslenme yönetimi yağdan fakir diyet, orta zincirli yağ asitlerinden zengin enteral beslenme ve total parenteral beslenmeyi içerdi. On dört hastaya oktreotid, dört hastaya duktus torasikus ligasyonu ve dört hastaya plörodezis uygulandı. Dokuz hastada sepsis gözlendi ve üç hasta kaybedildi. So nuç:Pediatrik kardiyak cerrahi sonrası gelişen şilotoraks nadir olmayan bir komplikasyondur. En sık tek ventrikül tamiri sonrasında gelişir ve ameliyat sonrası klinik seyir ve morbidite üzerinde anlamlı etkiye sahiptir.Anah tarsöz cük ler: Kardiyak cerrahi; çocuklar; şilotoraks. ABSTRACT Background:This study aims to evaluate the incidence, treatment protocols, and impact of chylothorax on early outcomes after pediatric cardiovascular surgery. Methods: Records of 1,123 pediatric patients who underwent heart operation at our clinic between June 2011 and June 2014 were reviewed retrospectively. Thirty-five patients (19 males, 16 females; median age 240 days; range 5 days to 15 years) who developed postoperative chylothorax were included in the study. Results: Development of chylothorax was detected most frequently in single ventricle repairs (n=11, 31%). It was followed by aortic arch repairs (n=9, 25%), tetralogy of Fallot (n=4, 1%), atrioventricular septal defect repairs (n=4, 11%), arterial switch operations (n=3, 8%), ventricular septal defect repairs (n=2, 6%), and other operations (n=2, 6%). Median duration of drainage of chylothorax was nine days (range, 2 to 44 days). Nutritional management included low lipid diet, enteral feedings enriched with mediumchain triglycerides, and total parenteral nutrition. Fourteen patients were administered octreotide, four patients were administered thoracic duct ligation, and four patients were administered pleurodesis. Sepsis was observed in nine patients and three patients died. Conclusion: Chylothorax developing after pediatric cardiac surgery is not a rare complication. It occurs most frequently after single ventricle repair and has a significant impact on postoperative clinical course and morbidity.

Evaluation of tracheostomy patients in a pediatric cardiac intensive care unit: our five-year single-center experiences

“…[14,15] Additional well-defined complications in these patients, which may lead to prolonged mechanical ventilation following cardiac surgery and may deteriorate respiratory function, are chronic pleural effusion and chylothorax. [15,16] In consistent with the literature data, we also observed three patients (16.6%) with diaphragmatic paralysis, three (16.6%) with pleural effusion, two (11%) with chylothorax, and one (5.5%) with tracheomalacia.…”

Ten-Year Clinical Experience on Chylothorax after Cardiovascular Surgery

“…A milky, serous, or transudative chylous pleural effusion has been described in patients after cardiac surgery. The rate of chylothorax after cardiothoracic procedures has been reported as 2.4% to 5.4% in patients who have undergone cardiovascular surgery [Doğan 2004;Hillerdal 1997;Yıldız 2015;Kara 2014]. It has been detected more frequently in the pediatric age group compared with adults [Sapmaz 2018].…”

“…It has been detected more frequently in the pediatric age group compared with adults [Sapmaz 2018]. The classic appearance of chylothorax is milky [Doğan 2004;Hillerdal 1997;Yıldız 2015], but appearance of chylothorax and pseudochylothorax may be serous or transudative [Sapmaz 2018;Cannizzaro 2006;Yeh 2013]. The presence of chylomicrons in pleural effusion is considered the gold standard in diagnosing chylothorax and pseudo-chylothorax [Doğan 2004;Hillerdal 1997;Yıldız 2015;Kara 2014;Sapmaz 2018;Cannizzaro 2006;Yeh 2013;Chan 2005].…”

“…The classic appearance of chylothorax is milky [Doğan 2004;Hillerdal 1997;Yıldız 2015], but appearance of chylothorax and pseudochylothorax may be serous or transudative [Sapmaz 2018;Cannizzaro 2006;Yeh 2013]. The presence of chylomicrons in pleural effusion is considered the gold standard in diagnosing chylothorax and pseudo-chylothorax [Doğan 2004;Hillerdal 1997;Yıldız 2015;Kara 2014;Sapmaz 2018;Cannizzaro 2006;Yeh 2013;Chan 2005]. If the triglyceride (TG) level of a pleural effusion is <2.77 mmol/L, the diagnosis of chylothorax may be excluded [Sapmaz 2018].…”

Post-Operative Chylothorax in Children Undergoing Congenital Heart Surgery

“…Several mechanisms are responsible for post-operative complication of chylothorax: damage to the thoracic duct while cannulating superior vena cava during cardio-pulmonary bypass, surgical trauma to thoracic duct and/or disruption of accessory lymphatic vessels during dissection, increased central venous pressure (exceeding lymphatic pressure) after partial or complete cavo-pulmonary anastomosis and development of central venous thrombosis (both preventing drainage of the thoracic duct) [4,5]. Risk factors include [2,3] type of procedure and its complexity (1% for Risk Adjustment for Congenital Heart Surgery [RACHS] score 1 and 5.6% for RACHS score 5 and 6), low weight and height, duration of cardiopulmonary bypass and crossclamping, and presence of syndromes, in particular Down syndrome, Noonan's syndrome and Turner's Syndrome (the latter two are 4-7 times more likely to develop chylothorax due to lymphangiectasia, abnormal lymphatic collaterals and spontaneous chylothorax) [3,[9][10][11][12]. Right ventricular dysfunction after total correction of tetralogy of Fallot predisposes to chylothorax by increasing right atrial central venous pressures [13].…”