Reconstruction of occluded thoracic duct for treatment of chylopericardium: a novel surgical therapy.
Chylopericardium is an uncommon disease predominantly caused by trauma. Prolonged chyle depletion may result in nutritional, metabolic, and immunologic deficiencies due to loss of essential proteins, immunoglobulins, fat, vitamins, electrolytes, and water. Medical treatment includes a low-fat diet with medium-chain triglyceride restriction, cardiac support, diuretic medications, and drainage of the pericardial effusion. Conventional surgical therapy consists of pericardial fenestration and thoracic duct ligation. We report a case of massive secondary chylous pericardial effusion successfully treated with microsurgical lymphovenous anastomosis, reconnecting the occluded thoracic duct to the internal jugular vein. This case highlights features and management strategies of this perplexing clinical condition.
Melduni
Rowlens M
RM
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. melduni.rowlens@mayo.edu
Oh
Jae K
JK
Bunch
T Jared
TJ
Sinak
Lawrence J
LJ
Gloviczki
Peter
P
D000368:Aged; D003251:Constriction, Pathologic; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008220:Lymphography; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013897:Thoracic Duct / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods*