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

Abstract

A 58-year-old Asian male underwent an uneventful triple coronary bypass that included a pedicled left internal mammary artery (LIMA) graft. On the third postoperative day, following resumption of full oral intake he developed a high output left-sided chylothorax. Initial therapy with a medium chain trigylceride diet and intercostal drainage showed no improvement. CT scan demonstrated a chylopericardium that was drained percutaneously. Complete resolution occurred 2 weeks later with adequate drainage and institution of total parenteral nutrition avoiding further surgery. We discuss the etiology and management of this rare complication following coronary surgery.

Early Chylothorax After Coronary Artery Bypass Grafting

“…Another procedure that may be associated with injury to thoracic duct is insertion of central venous pressure line from left internal jugular vein. In the neck, thoracic duct has an upward curved course and after down ward rotation, posterior to the first portion of the left subclavian artery, it jointed to the left internal jugular vein that may be injured by repeated trauma of CVP line insertion [7]. During OPCAB, lymphatic ducts may be injured in the region of the thymus or near the origin of the internal thoracic artery, which is destination site of thoracic duct during harvesting of LIMA.…”

Use of midodrine for treatment of chylopericardium after coronary artery bypass grafting

“…Pigtail pericardial drain removed and replaced with larger drain and left-sided pleural drain inserted, tunneled feeding line introduced into left subclavian vein. Postoperatively NBM with TPN Narayan et al, 2007 11 Pericardium CABG 65/F MCT diet, octreotide, surgical clip of severed lymphatic duct in thymic area Sachithanandan et al, 2008 12 Pericardium and left pleura CABG 58/M TPN and MCT diet Chaloob et al, 2008 13 Pericardium AVR 50/M Oversew of bilateral divided thymic lobes Szabados et al, 2011 14 Pericardium CABG 46/F MCT diet and SC octreotide Albage et al, 2011 15 Pericardium On-pump CABG 74/M TPN, I.V. somatostatin, and ligation of thoracic duct in posterior mediastinum adjacent to diaphragm Mundra et al, 2011 16 Pericardium AVR 54/M Pericardial window and thoracic duct ligation Cheng et al, 2013 17 Pericardium AVR and CABG 59/M Fat-free diet Pericardium AVR 45/F Fat-free diet, MCT oil, and octreotide Koutsogiannidis et al, 2013 18 Pericardium ASD closure 36/F TPN and MCT diet Karaca et al, 2014 19 Pericardium Ascending aorta replacement 47/M TPN and I.V.…”