Management of pediatric postoperative chylothorax

Bond, Sheldon J.; Guzzetta, Philip C.; Snyder, Matthew L.; Randolph, Judson G.

doi:10.1016/0003-4975(93)90881-h

Cited by 83 publications

(77 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Postoperative chylothorax is initially treated conservatively, based on the drainage of the pleural space and nutritional support, with the use of medium-chain triglycerides 7 , low-fat oral diet or enteral rest by giving parenteral nutrition 17 . However, the use of medium-chain triglycerides is avoided by some physicians, after the Peitersen and Jacobsen 18 study demonstrated the substantial increase in triglyceride content in pleural effusion.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ligation of the thoracic duct for the treatment of chylothorax in heart diseases

Pêgo‐Fernandes

Jatene

Tokunaga

et al. 2003

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

If conservative treatment is not effective, surgical treatment should be considered 8 . Studies indicate that ligation of the thoracic duct and pleurodesis are efficient alternatives for resolution of chylothorax 9 .Recently, thoracic duct ligation through video-assisted thoracic surgery has been used in patients who did not respond to conservative treatment. Kirby et al 11 describe this conduct as less painful and with fewer postoperative complications.Pereira et al 12 describe the use of lymphatic ligation for the treatment of postoperative chylopericardium. However, in our country, ligation of the thoracic duct for the treatment of postoperative chylothorax is still a rare procedure, and at what point the conservative treatment should be replaced by postsurgical treatment is still controversial. Thus, our study evaluates the initial results of ligation of the thoracic tract in 4 patients with chylothorax unresponsive to conservative treatment. Case ReportsCase 1 -A four-year-old-male patient with congenital cardiopathy and cyanosis at birth with a previous history of pulmonary atresia without interventricular communication, single left ventricle, hypoplastic right ventricle with sinusoids, left pulmonary artery stenosis, and coronary artery cavitary fistulas. At 5 days of life, he underwent atrial septotomy with the Rashkind procedure, and after 2 days, he underwent a modified left Blalock Taussig shunt procedure. At 4 years old, he underwent a bidirectional Glenn operation with maintenance of the previous Blalock shunt, evolving, in the postoperative period with low cardiac output maintained with vasoactive drugs. He was discharged on the 5th postoperative day, when minor pleural effusion was suspected. A chest X-ray was indicated.After chylothorax was diagnosed, pleural drainage was started. Parenteral nutrition and fasting were introduced after 1 week. The patient evolved with significant persistence of pleural drainage. Nineteen days after the initial In children, chylothorax occurs mainly after cardiac and thoracic surgeries. One of the recommended postsurgery treatments is ligation of the thoracic tract, when all other conservative treatments have failed. We report 4 cases of chylothorax in patients who were successfully treated with this approach, which resulted in a decrease in pleural drainage without recurrent chylothorax.Chylothorax refers to the presence of lymphatic fluid in one or both pleural spaces, secondary to leakage in the thoracic duct or one of its main tributaries 1 . Quinke 2 first described traumatic chylothorax in 1875, after rupture of the thoracic duct.When chylothorax is not treated, the risk of death is high, with rates above 45% 3 , requiring, in the majority of the cases, aggressive treatment.According to DeMeester 4 , chylothorax may be according to its cause, either congenital, traumatic, neoplastic, or multiple causes. Among the traumatic causes surgical procedures with a thoracic approach may cause thoracic duct lesions, leading to the development of chylothorax. Postoperat...

show abstract

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment of chylothorax includes pleurodesis 19 , ligation of the lymphatic vessels, and ligation of the thoracic duct 17 .…”

Section: Discussionmentioning

confidence: 99%

Ligation of the thoracic duct for the treatment of chylothorax in heart diseases

Pêgo‐Fernandes

Jatene

Tokunaga

et al. 2003

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

show abstract

“…Chylothorax also occurs after intrapericardial procedures, such as Glenn and Fontan procedures, without obvious trauma to lymphatic vessels. (6,7) These operations generate high central venous pressure, leading to high lymphatic pressure and lymphorrhea. The loss of lymph after drainage, sometimes in great quantities, can lead to nutritional depletion, electrolyte disturbances, hypolipemia, and lymphocytopenia with immunodeficiency.…”

Section: Introductionmentioning

confidence: 99%

“…Such complications are poorly tolerated in small infants with severe heart disease and are associated with high mortality when left untreated. (3)(4)(5)(6)(7)(8) Patients usually remain asymptomatic, presenting with pronounced chylous effusion only after being started on a regular diet. The initial management consists of pleural drainage, allowing lung expansion, and dietary strategies to decrease lymphorrhea.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Videotoracoscopia como uma opção no tratamento cirúrgico do quilotórax após cirurgia cardíaca pediátrica

et al. 2011

View full text Add to dashboard Cite

Objective: To evaluate the use of video-assisted thoracoscopy in the surgical treatment of chylothorax developed after the surgical correction of congenital heart disease in children. Methods: We reviewed the medical charts of 3,092 children who underwent surgery for congenital heart disease between February of 2002 and February of 2007 at the Heart Institute of the University of São Paulo School of Medicine Hospital das Clínicas, in São Paulo, Brazil. Results: Of the 3,092 children, 64 (2.2%) presented with chylothorax as a postoperative complication. In 50 (78.1%) of those patients, the clinical management was successful, whereas it failed in 14 (21.9%), all of whom were then submitted to thoracic duct ligation by video-assisted thoracoscopy. The thoracic duct ligation was successful in 12 patients (86%) but failed in 2. In the postoperative period, additional clinical measures, such as a low-fat diet and parenteral nutrition, were required in order to resolve those 2 cases. There was no surgical morbidity or mortality. Of the 14 patients who underwent thoracic duct ligation, 5 (35%) died due to cardiac or infectious complications. Conclusions: Video-assisted thoracic duct ligation can be safely performed in patients with severe heart disease, and the outcomes are favorable.Keywords: Chylothorax; Heart defects, congenital; Thoracic duct. ResumoObjetivo: Avaliar o uso de videotoracoscopia no tratamento cirúrgico do quilotórax após cirurgia para correção de cardiopatias congênitas em crianças. Métodos: Revisamos os prontuários médicos de 3.092 crianças operadas para a correção de cardiopatias congênitas no Instituto do Coração/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP) entre fevereiro de 2002 e fevereiro de 2007. Resultados: Das 3.092 crianças, 64 (2,2%) apresentaram quilotórax como complicação pós-operatória. Em 50 (78,1%) dessas, o tratamento clínico foi bem-sucedido, enquanto esse falhou em 14 (21,9%), as quais foram submetidas à ligação do ducto torácico por videotoracoscopia. A ligação do ducto torácico obteve sucesso em 12 pacientes (86%) e falhou em 2 casos, os quais foram resolvidos com medidas clínicas adicionais, como dieta pobre em gorduras e nutrição parenteral. Não houve morbidade ou mortalidade relacionada à operação. Dos 14 pacientes, 5 (35%) faleceram em decorrência de complicações cardíacas ou infecciosas. Conclusões: A ligadura videoassistida do ducto torácico pode ser realizada com segurança em pacientes gravemente enfermos e com doença cardíaca grave, com resultados favoráveis.

show abstract

Bronchial casts in children with cardiopathies: The role of pulmonary lymphatic abnormalities

et al. 1999

View full text Add to dashboard Cite

Expectoration of bronchial casts, a condition also called plastic bronchitis, is very rare in children. Bronchial casts may be associated with bronchopulmonary diseases associated with mucus hypersecretion, bronchopulmonary bacterial infections, congenital and acquired cardiopathies, or pulmonary lymphatic abnormalities. A classification based on anatomy and pathology has been proposed which identifies an “acellular” group associated with congenital cardiopathies and palliative surgery. We report on 3 cases with bronchial casts associated with cardiopathy. Observations suggest that the formation of bronchial casts may result from lymphatic leakage into the bronchi. The 3 cases on which we report were immunodeficient and had pulmonary lymphatic abnormalities. The bronchial casts contained lymphocytes and lipids, as determined by histologic examination. In the absence of congenital pulmonary or diffuse lymphatic dysplasia associated with cardiopathy, the principal factors resulting in the formation of bronchial casts appear to be surgical trauma to the lymphatic channels surrounding the bronchi, pleural adhesions, and high systemic venous blood pressure. The prognosis for these patients is poor, and possibilities for treatment are limited. Pediatr Pulmonol. 1999;28:329–336. © 1999 Wiley‐Liss, Inc.

show abstract

Management of pediatric postoperative chylothorax

Cited by 83 publications

References 20 publications

Ligation of the thoracic duct for the treatment of chylothorax in heart diseases

Ligation of the thoracic duct for the treatment of chylothorax in heart diseases

Videotoracoscopia como uma opção no tratamento cirúrgico do quilotórax após cirurgia cardíaca pediátrica

Bronchial casts in children with cardiopathies: The role of pulmonary lymphatic abnormalities

Contact Info

Product

Resources

About