Thoracic Duct Ligation and Pericardectomy for Treatment of Idiopathic Chylothorax

Abstract

Chylothorax is a devastating disease, and the success rates from either medical or surgical management are less than satisfactory. In some animals with chylothorax, a thickening of the pericardium occurs that is associated with chronic irritation induced by chyle. We hypothesized that pericardial thickening would lead to increased right-sided venous pressures and that abnormal venous pressures would act to impede the drainage of chyle via lymphaticovenous communications after thoracic duct (TD) ligation. We also hypothesized that serosanguineous effusions that occurred after TD ligation could effectively be treated or prevented by pericardectomy in affected animals. TD ligation plus pericardectomy was performed in 17 animals, and pericardectomy alone was performed in an additional 3 animals that presented during a 5.5-year period to the Texas A&M University (College Station, TX). Nineteen animals presented for an evaluation of idiopathic chylothorax (9 dogs and 10 cats), and 1 dog presented for serosanguineous pleural fluid after TD ligation that had been performed elsewhere. Echocardiography was normal in all animals, except for a subjectively thickened pericardium in 7 cats and 6 dogs. Clinical signs of pleural fluid accumulation resolved in 10 of 10 dogs and in 8 of 10 cats after surgery. The overall success rate for the surgical treatment of chylothorax (ie, the resolution of pleural fluid accumulation) in this study was 90% (100% in dogs and 80% in cats). These data suggest that TD ligation in conjunction with pericardectomy has a favorable outcome in animals with idiopathic chylothorax.

Single Paracostal Approach to Thoracic Duct and Cisterna Chyli: Experimental Study and Case Series

“…The aim of SPE is to decrease right‐sided venous pressure, thus facilitating drainage of the chyle into the venous system. When CCA or SPE is performed concurrently with TDL, success rates for resolution of chylothorax increase to 80–90% . Recent comparison of outcomes after various combination of these procedures suggest that TDL + CCA have a superior outcome compared with TDL + SPE .…”

Advances in Video-Assisted Thoracic Surgery, Thoracoscopy

“…pericardectomy, and/or cysterna chili ablation. [34][35][36][37][38] Because access to multiple regions of the body is needed for these procedures, a video-assisted thoracic approach to the thoracic duct and pericardium may be of significance in dogs undergoing surgical treatment of idiopathic chylothorax. Two techniques have been described for VATS thoracic duct ligation and pericardectomy in dogs.…”

Pericardial Diseases

“…Idiopathic hemorrhagic pericarditis can sometimes evolve into constrictive pericarditis. Chylothorax is another etiology: the presence of chyle in the pleural space has an irritating effect on the pericardium and can induce constrictive pericarditis [30].…”