Octreotide--additional conservative therapy for postoperative chylothorax in congenital heart disease.
BACKGROUND
Chylothorax is a rare but serious postoperative condition in children with congenital heart disease. Conventional medical treatment consists of specific long-term dietary modification, and surgical reintervention, such as lymphatic duct ligation, may be indicated in refractory cases. In recent years, an additional conservative treatment, octreotide, a synthetic analog of somatostatin, has been used in management of congenital and postoperative chylothorax.


METHODS
The objective of this work was to analyze the efficacy and safety of this treatment for chylothorax after congenital heart surgery. We reviewed the records of sixteen patients with chylothorax after surgery for congenital heart disease between January 1999 and December 2007, and collected the following data: demographic information; type of surgical procedure; onset, duration and management of chylothorax and treatment; and duration of hospital stay. To analyze efficacy we compared these parameters in children receiving conventional treatment only with those receiving octreotide. To analyze safety we compared the adverse effects of both treatments. Octreotide was administered at a dose of 4 to 10 microg/kg/hour, with monitoring of side effects.


RESULTS
The incidence of chylothorax in our population was 1.6%. It occurred more often after Glenn and Fontan procedures (8 patients). Octreotide was begun three days after diagnosis of chylothorax and continued for a median of seventeen days (ranging from 4 to 26 days), until complete resolution. Side effects were frequent (in 3 of the 8 patients) but of no clinical relevance. All patients responded to the therapy and there was no indication for further surgical intervention.


CONCLUSIONS
Octreotide is safe and effective in the treatment of postoperative chylothorax in children with congenital heart disease. It is a useful adjunctive therapy to the conventional treatment of this complication.
Paramés
Filipa
F
Serviço de Cardiologia Pediátrica, Centro Hospitalar de Lisboa Central - Hospital de Santa Marta, Lisboa, Portugal. f_parames@hotmail.com
Freitas
Isabel
I
Fragata
José
J
Trigo
Conceição
C
Pinto
Maria Fátima F
MF
D002648:Child; D002675:Child, Preschool; D002916:Chylothorax / Q000188:drug therapy*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015282:Octreotide / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies
D015282:Octreotide