Patologia del Pericardio. Videopericardioscopia Con Accesso Sottoxifoideo

Pêgo‐Fernandes, Paulo Manuel; Fonseca, Marcelo Heleno

doi:10.1007/978-88-470-0522-8_37

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“…Chylothorax is a lymphatic fluid extravasation into pleural cavity. In undergoing cardiac surgery children, chylothorax incidence is between 0.25% and 5.3% [ 1 - 6 ] and may occur through direct injury, mainly in the correction of the ductus arteriosus and coarctation of the aorta, due to the anatomical proximity to the thoracic duct originating from the chyle cistern, between L3 and T10, ascends to the thoracic region at the time of aortic hiatus between T10 and T12, and ends its course in an anastomosis at the junction of the subclavian vein and left internal jugular vein [ 7 ] . It is also frequently related to surgeries for correction of right ventricular outflow obstruction: tetralogy of Fallot and atresia of the pulmonary artery with or without ventricular septal defect.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Treatment of Chylothorax in Children Undergoing Corrective Surgery for Congenital Heart Diseases

Christofe¹,

Pessotti²,

Paiva³

et al. 2017

Braz J Cardiovasc Surg

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IntroductionChylothorax is a lymphatic extravasation into pleural cavity and its incidence is 0.25%-5.3% in children undergoing cardiac surgery.ObjectiveTo evaluate the incidence of chylothorax in pediatrics patients operated, linking it in each surgical intervention. Evaluate treatment types and efficiency.MethodsRetrospective study using medical records of children undergoing cardiac surgery in the Hospital do Coração between 2004 and 2014. For statistical analysis, qualitative variables by absolute frequency and relative frequency; quantitative variables, by median of 25 and 75 percentiles, as they did not present normal distribution (Shapiro-Wilk, P<0.05). The Chi-square test was used for the association between type of treatment and result. The adopted confidence level was 95%.ResultsIncidence of chylothorax was 2.1% (0.9% in intracardiac surgery, 1.7% correction of patent ductus arteriosus and aortic coarctation, 8.3% Glenn's surgery, 11.8% total cavopulmonary surgery and 3% in others). Among treatments, fasting associated with total parenteral nutrition (TPN) resolved 51% of the cases. Hypoglossal diet had failed treatment and surgical referral in 22% of the cases. Fasting with TPN associated with octreotide had success in the treatment of chylothorax in a period exceeding 15 days in 78% of cases, and 3.7% were referred for surgery.ConclusionAccording to the results, incidence of chylothorax was 2.18%. Treatment with fasting and TPN leads to resolutions in 86.5%, and the association with octreotide was successful in 85.1% of cases, showing an efficient option, while the treatment with hypoglossal diet had therapeutic failure in 22% of the cases in which it was used.

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Section: Introductionmentioning

confidence: 99%