Etiology and management of chylothorax following pediatric heart surgery.
BACKGROUND
Chylothorax after congenital heart surgery (CHD) is a potentially challenging complication. The purpose of this study was to review our experience with the management of chylothorax following congenital heart surgery.


METHODS
Between September 1997 and August 2006, of 1341 pediatric patients undergoing correction of congenital heart disease in our institution, 18 (1.3%) developed chylothorax postoperatively. Surgical procedures included tetralogy of Fallot repair in 10 patients, ventricular septal defect closure (one), atrial septal defect with pulmonary stenosis repair (one), Fontan procedure (three), coarctation of the aorta repair (one), aortopulmonary shunt (one), and ligation of patent ductus arteriosus in one patient. All patients followed a therapeutic protocol including complete drainage of chyle collection and controlled nutrition. Somatostatin was used adjunctively in six (33.3%) patients. Surgical intervention was reserved for persistent lymph leak despite maximal therapy. Following resolution of chylothorax, a medium-chain triglyceride diet was implemented for six weeks.


RESULTS
There were no deaths. Fifteen patients (83.3%) responded to conservative therapy. Lymph leak ranged from 2.5 to 14.7 mL/kg per day for 8 to 42 days. Three patients with persistent drainage required thoracotomy with pleurodesis to achieve resolution, in two of which previously attempted chemical pleurodesis with doxycycline proved ineffective. Duration of lymph leak in this subgroup ranged from 15 to 47 days with 5.1 to 7.4 mL/kg per day output.


CONCLUSIONS
Postoperative chylothorax is an infrequent complication of surgery for congenital heart disease and can occur even after median sternotomy in the absence of pathologically elevated venous pressure or Fontan circulation. Although hospitalization can be prolonged, conservative therapy is effective in most cases, while surgical pleurodesis proved successful in the refractory cases.
Milonakis
Michael
M
Department of Pediatric and Congenital Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece. milonakis@ath.forthnet.gr
Chatzis
Andrew C
AC
Giannopoulos
Nikolaos M
NM
Contrafouris
Constantinos
C
Bobos
Dimitrios
D
Kirvassilis
George V
GV
Sarris
George E
GE
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015505:Chest Tubes; D002675:Child, Preschool; D002916:Chylothorax / Q000209:etiology* / Q000628:therapy*; D004318:Doxycycline / Q000627:therapeutic use; D004322:Drainage; D004750:Enteral Nutrition; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D018700:Pleurodesis; D011183:Postoperative Complications / Q000628:therapy*; D013004:Somatostatin / Q000627:therapeutic use; D013908:Thoracotomy
D000900:Anti-Bacterial Agents; D006728:Hormones; D013004:Somatostatin; D004318:Doxycycline