Octreotide for management of chylothorax following bidirectional Glenn in a three-month-old infant.
BACKGROUND
Chylothorax developing after open heart surgery for congenital heart defects can be a challenging problem. Established therapies are not always efficacious. This report summarizes our experience using octreotide as an adjunct in the management of an intractable chylous effusion.


METHODS
The patient described underwent a bilateral bidirectional cavopulmonary anastomosis at 3 months of age. Postoperatively, the patient demonstrated significant quantities of milky fluid drainage from the right pleural chest tube. Initial management included diuretics, afterload reduction, and a non-fat diet. These maneuvers appeared to be effective. However, the patient experienced a recurrence of the effusion requiring re-admission to the hospital and re-insertion of a right pleural chest tube. Given the recalcitrant nature of the effusion, an infusion of octreotide was begun.


RESULTS
An octreotide infusion was begun at 1 mcg/kg/hr and gradually increased to 3 mcg/kg/hr. Chest tube drainage diminished allowing chest tube removal 13 days later. The octreotide infusion was weaned off over the subsequent 10 days without any further effusion problems.


CONCLUSIONS
Octreotide may be a useful adjunct in the management of intractable chylous effusions following congenital heart surgery.
Wright
Stanley B
SB
Department of Pediatric Cardiology, Children's Center at Sutter Medical Center, Sacramento, California, USA.
Mainwaring
Richard D
RD
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002916:Chylothorax / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D015282:Octreotide / Q000627:therapeutic use*
D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide