Incidence and treatment of chylothorax after cardiac surgery in children: Analysis of a large multi-institution database

Mery, Carlos M.; Moffett, Brady S.; Khan, Muhammad S.; Zhang, Wei; Guzmán-Pruneda, Francisco A.; Fraser, Charles D.; Cabrera, Antonio G.

doi:10.1016/j.jtcvs.2013.09.068

Cited by 143 publications

(184 citation statements)

References 15 publications

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“…However, in our study, patent ductus arteriosus ligation and repair of the ventricular septal defect (VSD) are the two most common procedures found to cause postoperative chylothorax. The risk factors for cardiothoracic surgery related chylothorax in children are: the complicated nature of the procedure, secondary chest tube closure, younger age, lower body weight, genetic syndromes, vein thrombosis, lengthy cardiopulmonary bypass, X-clamp time, and higher annual hospital volume [11, 12]. …”

Section: Discussionmentioning

confidence: 99%

Presentations and management of different causes of chylothorax in children: one medical center’s experience

Lin

Chang

2017

Biomedicine (Taipei)

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Background: Chylothorax in children is a relatively rare cause of pleural effusion. However, it is usually a common complication of cardiothoracic operations like open-heart surgery. Other etiologies for chylothorax, such as trauma or malignancy, occur more common in adults and rare in children. To explore the etiologies of chylothorax in children, this study analyzed the pediatric patients that were admitted in to onea medical center.Methods: We retrospectively reviewed the medical records of the pediatric patients that were admitted to this tertiary transfer center with a diagnosis of chylothorax during the period of 1995 to 2005.Results: A total of 22 patients (15 females and 7 males) with chylothorax were enrolled in our study. The etiologies for chylothorax were the following: a complication of cardiothoracic surgery in 14 patients (63.6%), congenital chylothorax in 5 patients (22.7%), association with neuroblastoma in 2 patients (9.1%), and congenital nephrotic syndrome in 1 patient (4.6%). All patients required medical therapy. Chest tube drainage was necessary to provide for twenty patients (90.9%), and surgical intervention was necessary to perform for 3 patients (13.6%). Four patients (18.2%) expired due to other causes.Conclusion: Cardiothoracic surgery was the most common cause of chylothorax in children at the institution surveyed. Medication and chest tube drainage were effective in treating most of these chylothorax-afflicted patients. In addition, early recognition, medication, and performing surgical intervention when necessary are important measures to avoid a catastrophe.

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Section: Discussionmentioning

confidence: 99%

Presentations and management of different causes of chylothorax in children: one medical center’s experience

Lin

Chang

2017

Biomedicine (Taipei)

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“…[7] The diagnosis of postoperative chylothorax was carried out by investigating the characteristics of the pleural fluid, and a triglyceride level of >110 mg/dL or a white cell count (WCC) of >1,000 cell/µL with a significant lymphocyte fraction (80%) confirmed its presence. [4,8] The onset of chylothorax was considered to be the point at which diagnostic fluid was first recovered.…”

Section: Methodsmentioning

confidence: 99%

“…Prolonged chylothorax places patients at risk for malnutrition, poor wound healing, infections, fluid imbalance, electrolyte abnormalities, prolonged mechanical ventilation and device utilization, and longer stays in the hospital and intensive care unit (ICU). [3,4] The first step in chylothorax treatment is the drainage of the pleural fluid to decrease the flow of the lymphatic fluid from the ductus thoracicus. This is followed by a low-fat or fat-free diet or the replacement of enteral food with liquid intake [nil per os (NPO)] or the use of total parenteral nutrition (TPN) including intravenous lipids.…”

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confidence: 99%

Chylothorax following pediatric cardiac surgery

Yıldız¹,

Öztürk²,

Altin³

et al. 2015

Turk Gogus Kalp Dama

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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.

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“…and Dugue et al . advocate a daily output threshold of 10 mL/kg body weight before considering thoracic duct ligation, but the timing for surgical revision after failure of conservative treatment, which can include total parenteral nutrition or medium chain triglyceride diets, is still unclear . Among patients with high or medium output chylothorax, high mortality rates associated with nonoperative management dictate earlier surgical revision, which has clinical success of up to 100%.…”

Section: Other Complications That May Influence the Conduit Or Anastomentioning

confidence: 99%

“…124 Brinkmann et al and Dugue et al advocate a daily output threshold of 10 mL/kg body weight before considering thoracic duct ligation, 124,127 but the timing for surgical revision after failure of conservative treatment, which can include total parenteral nutrition or medium chain triglyceride diets, is still unclear. [128][129][130] Among patients with high or medium output chylothorax, high mortality rates associated with nonoperative management dictate earlier surgical revision, which has clinical success of up to 100%. The optimal management of patient with low-volume chylothorax is also more questionable, although the prolonged wait time that accompanies nonoperative treatment is not without consequences.…”

Section: Pathophysiology Of Postoperative Pulmonary Complicationmentioning

confidence: 99%

Diagnosis, assessment, and management of surgical complications following esophagectomy

Grimminger

Goense

Gockel

et al. 2018

Annals of the New York Academy of Sciences

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Incidence and treatment of chylothorax after cardiac surgery in children: Analysis of a large multi-institution database

Abstract: Chylothorax is a significant problem in pediatric cardiac surgery and is associated with increased mortality, cost, and length of stay. Strategies should be developed to improve prevention and treatment.

Cited by 143 publications

References 15 publications

Presentations and management of different causes of chylothorax in children: one medical center’s experience

Presentations and management of different causes of chylothorax in children: one medical center’s experience

Chylothorax following pediatric cardiac surgery

Diagnosis, assessment, and management of surgical complications following esophagectomy

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