Surgical Management of Congenital Chylothorax in Children

Nué, R. Le; Molinaro, Francesco; Gomes-Ferreira, C.; Scheib-Brolly, C.; Escande, B; Kühn, Peter; Lacreuse, I.; Favre, R.; Baudin, François

doi:10.1055/s-0030-1254164

Cited by 30 publications

(27 citation statements)

References 16 publications

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“…Surgical management with pleural abrasion and pleurectomy has been advocated by some centres to be an effective alternative for large, refractory effusions. 18 An algorithm for management of chylothorax based on the experience in our centre is proposed (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

Congenital chylothorax: Associations and neonatal outcomes

Downie

Sasi

Malhotra

2013

J Paediatrics Child Health

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Aim Congenital chylothorax is a rare but significant neonatal entity with major morbidity and mortality. The study aims to describe the related associations, management and outcomes of this condition in neonates. Methods This is a retrospective case series of all cases of congenital chylothorax admitted to a tertiary neonatal centre in the last 15 years. Results Ten cases of congenital chylothorax were identified. Eight infants were diagnosed antenatally and three infants had antenatal pleural drainage. Most infants were ventilated at birth and required immediate pleurocentesis. Post‐natal management included drainage of fluid, ventilation, albumin replacement, octreotide and dietary modification with medium‐chain triglyceride‐enriched formula. Five infants had chromosomal aberrations identified, while a further two had dysmorphic features not substantiated with routine genetic testing. Noonan's syndrome was the single most common underlying genetic diagnosis. Associated anomalies and malformations were present in 80% of the cohort. There were two deaths in the series, both in infants with multiple co‐morbidities. Conclusions Congenital chylothorax is a rare condition with overall prevalence of less than a case per year in our experience. Majority of infants had associated chromosomal anomalies and significant co‐morbidities needing prolonged intensive care.

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Section: Discussionmentioning

confidence: 99%

Congenital chylothorax: Associations and neonatal outcomes

Downie

Sasi

Malhotra

2013

J Paediatrics Child Health

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“…Several authors advocate for early thoracic duct ligation or pleurodesis in patients failing conservative medical treatment. (16-18) It is not yet possible to identify the subset of patients who will drain for long times and consequently be at risk for protein malnutrition, electrolyte, and immunologic abnormalities. We believe that spontaneous resolution of chylothorax is unlikely when initial drainage volume is excessive.…”

Section: Commentmentioning

confidence: 99%

Utility of a Clinical Practice Guideline in Treatment of Chylothorax in the Postoperative Congenital Heart Patient

Yeh¹,

Brown²,

Kellogg³

et al. 2013

The Annals of Thoracic Surgery

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Background Chylothorax following congenital heart surgery is a common complication with associated morbidities, but consensus treatment guidelines are lacking. Variability exists in the duration of medical treatment and timing for surgical intervention. Methods Following institution of a clinical practice guideline for management of post-operative chylothorax at a single center, pediatric cardiothoracic intensive care unit (ICU) in June 2010, we retrospectively analyzed two cohorts of patients: those with chylothorax from 1/2008-5/2010 (early cohort; n = 118) and from 6/2010-8/2011 (late cohort; n = 45). Data collected included demographics, cardiac surgical procedure, treatments for chylothorax, bloodstream infections, hospital mortality, length of hospitalization, duration of mechanical ventilation, and device utilization. Results There were no demographic differences between the cohorts. No differences were found in octreotide use or surgical treatments for chylothorax. Significant differences were found in median times to chylothorax diagnosis (9 in early cohort versus 6 days in late cohort, p = 0.004), ICU length of stay (18 vs. 9 days, p = 0.01), hospital length of stay (30 vs. 23 days, p = 0.005), and total durations of mechanical ventilation (11 vs. 5 days, p = 0.02), chest tube use (20 vs. 14 days, p = 0.01), central venous line use (27 vs. 15 days, p = 0.001), and NPO status (9.5 vs. 6 days, p = 0.04). Conclusions Institution of a clinical practice guideline for treatment of chylothorax following congenital heart surgery was associated with earlier diagnosis, reduced hospital length of stay, mechanical ventilation, and device utilization for these patients.

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“…The right thoracotomy is the most easy and efficient incision to ligate the thoracic duct when the patient has no situs inversus [8]. Some authors have shown the benefit of prophylactic mass ligation of the thoracic duct in patients who underwent oesophagectomy and pulmonary resection [9]. However, the interest of the prophylactic ligation has not been verified in children with congenital cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Chylothorax Complicating Closure of the Ductus Arteriosus: The Second Case

Ennazk

Echouka

Houati³

et al. 2013

Case Reports in Surgery

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Chylothorax is a possible complication of intrathoracic surgery. The diagnosis of postoperative chylothorax is easy; however, the treatment can cause problems of management because of the lack of consensus. In children, the most common causes of postoperative chylothorax are the cures for congenital heart diseases. We report the case of a two-year-old child, presenting with a chylothorax following surgery of the ductus arteriosus. Our case illustrates the treatment that must first include medical measures without delaying the surgery. The risk is the installation of nutritional and immune deficiency.

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Surgical Management of Congenital Chylothorax in Children

Cited by 30 publications

References 16 publications

Congenital chylothorax: Associations and neonatal outcomes

Congenital chylothorax: Associations and neonatal outcomes

Utility of a Clinical Practice Guideline in Treatment of Chylothorax in the Postoperative Congenital Heart Patient

Chylothorax Complicating Closure of the Ductus Arteriosus: The Second Case

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