Postoperative Chylothorax in Neonates and Infants after Congenital Heart Disease Surgery—Current Aspects in Diagnosis and Treatment

Abstract

Postoperative chylothorax is a rare complication following cardiac surgery for congenital heart disease (CHD) in the pediatric population, including neonates and infants. Multiple mechanisms are involved in the development of postoperative chylous effusions, mainly the traumatic injury of lymphatic vessels, systemic venous obstruction and dysfunction of the right ventricle. In this review, we focus on the existing evidence regarding the definition and diagnosis of postoperative chylothorax in children with CHD, as well as current therapeutic approaches, both nutritional and interventional, for the management of these patients. As part of nutritional management, we specifically comment on the use of defatted human milk and its effect on both chylothorax resolution and patient growth. A consensus with regard to several key aspects of this potentially significant complication is warranted given its impact on the cost, morbidity and mortality of children with CHD.

Incidence, risk factors, and outcomes of chylothorax after cardiac procedure in the United States

“…The study supports previous research that shows higher incidence rates of chylothorax in pediatric patients compared to adults [ 19 ]. Additionally, infants had a higher incidence of chylothorax than children and adolescents.…”

Risk Factors of Chylothorax After Congenital Heart Surgery in Infants: A Single-Centre Retrospective Study

“…Surgical trauma, especially cardiac surgery, is the main cause of traumatic chylothorax. 3 According to reports from the Pediatric Cardiac Critical Care Consortium and the Pediatric Health Information System databases, 4 the overall incidence of chylothorax in paediatric patients following congenital heart surgery or heart transplantation ranges from 2.8% to 3.8%. However, the incidence in China is approximately 3%–5%.…”

Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis

“…Postoperative chylothorax is usually caused by injuries to the thoracic duct or to its tributaries during surgery [ 4 ] . Chylothorax may happen in several types of cardiothoracic surgery, including esophagectomy, lobectomy, cardiac procedures, and mediastinal tumors resection [ 5 , 6 , 7 , 8 , 9 ] . The diagnosis of chylothorax consists of evaluating triglyceride levels, cholesterol values, and microscopy crystals [ 10 ] .…”