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Chylothorax after surgery for congenital heart disease in children

Published online by Cambridge University Press:  19 August 2008

Simone Rolim Fernandes Fontes Pedra ,
Carlos Augusto Cardoso Pedra ,
Valmir Fernandes Fontes ,
Maria Virgínia Tavares Santana  and
Paulo Paredes Paulista
Simone Rolim Fernandes Fontes Pedra*
Affiliation:
Departments of Pediatric Cardiology and Cardiovascular Thoracic Surgery, “Dante Pazzanese”Institute of Cardiology, São Paulo, Brazil
Carlos Augusto Cardoso Pedra
Affiliation:
Departments of Pediatric Cardiology and Cardiovascular Thoracic Surgery, “Dante Pazzanese”Institute of Cardiology, São Paulo, Brazil
Valmir Fernandes Fontes
Affiliation:
Departments of Pediatric Cardiology and Cardiovascular Thoracic Surgery, “Dante Pazzanese”Institute of Cardiology, São Paulo, Brazil
Maria Virgínia Tavares Santana
Affiliation:
Departments of Pediatric Cardiology and Cardiovascular Thoracic Surgery, “Dante Pazzanese”Institute of Cardiology, São Paulo, Brazil
Paulo Paredes Paulista
Affiliation:
Departments of Pediatric Cardiology and Cardiovascular Thoracic Surgery, “Dante Pazzanese”Institute of Cardiology, São Paulo, Brazil
*
Simone RF Fontes, Pedra Address Av. Dr Dante Pazzanese, 500 Ibirapuera Cx Postal 215. 04012-180 - São Paulo - SP - Brazil. Tel: (011) 549-1144 Ext. 214. Fax. (011) 571-5621
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Abstract

We reviewed retrospectively the clinical and surgical data from 9 children with postoperative chylothorax secondary to cardiac surgery for congenital heart disease seen over a 3 year period. Mean age was 26 months and 6 patients were female. The procedures performed were 2 Blalock-Taussig shunts, 6 Bidirectional Glenn anastomoses and 1 modified Fontan procedure. Diagnosis of chylothorax was made by classical means. The overall incidence of chylothorax was 0.8%, with the relative incidences being 2.5% for Blalock-Taussig, 2.7% for Fontan, and 11.7% for the Glenn procedures. All patients were initially treated conservatively with chest tube drainage and hypercaloric diet suplemented with medium chain triglycerides. Parenteral nutrition was needed in 2 patients, one because of sepsis and the other because of progressive malnourishment. High output fistulas and long periods of drainage were noted after cavo-pulmonary procedures. Up to 12% weight loss was observed in 6 patients, one patient was successfully treated of pneumonia and another died of Pseudomonas aeruginosa sepsis. Two patients required chemical pleurodesis because of unabated drainage, with the others being successfully treated conservatively. Chylothorax is a common complication after bidirectional Glenn procedures, and is associated with considerable morbidity and mortality. Earlier operative intervention may be required in these patients. Pleurodesis is a simple, safe, and effective procedure to stop chylous flow.

Keywords

Chylothoraxpostoperativecongenital heart diseasemanagement
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 2 , April 1998 , pp. 199 - 204
Copyright
Copyright © Cambridge University Press 1998

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