title: Balloon Angioplasty for the Treatment of Left Innominate Vein Obstruction Related Chylothorax after Congenital Heart Surgery.
abstract: OBJECTIVE
  Chylothorax complicates the postoperative course of patients after congenital heart surgery. Innominate vein thrombosis and stenosis have been associated with postoperative chylothorax. Revascularization and angioplasty can be accomplished using transcatheter techniques. We report our experience with this procedure for the management of postoperative chylothorax.
  
  
  METHODS
  This is a retrospective case series of patients who underwent catheter revascularization and/or angioplasty of the innominate vein following cardiac surgery at our institution from January 1, 2008 through April 9, 2014.
  
  
  METHODS
  The cardiovascular intensive care unit and cardiac catheterization laboratory at the University of Alabama at Birmingham and Benjamin Russell Hospital for Children in Birmingham, Alabama were used as settings for the study.
  
  
  METHODS
  Out of 112 patients with postoperative chylothorax, 7 (6.3%) underwent transcatheter dilation of the innominate vein for occlusion/stenosis. The median age of the cohort was 1 month (15 days-6 years); median weight was 3 kg (2.7-22.2). Diagnosis was made a median 8 days (2-20) and persisted for a median of 24 days (9-44). Most patients failed medical management (low fat diet, nothing by mouth, and/or octreotide).
  
  
  RESULTS
  Cardiac catheterization occurred at a median 9 days (2-29) after chylothorax diagnosis. Median chest tube output on the day prior to procedure was 63 (12-149) cc/kg/day and decreased to 23 (0-64) cc/kg/day 2 days postprocedure (P = .01). Effusions resolved in a median of 5 days (1-16). There were no clinical complications postcatheterization. All patients who have undergone repeat angiography have maintained patency of the innominate vein. There was no mortality. Complications from chylothorax included prolong hospitalization, hyponatremia, hypoproteinemia, coagulopathy, lymphopenia, and infection.
  
  
  CONCLUSIONS
  Innominate vein occlusion and stenosis associated with chylous effusion are amenable to transcatheter revascularization and/or angioplasty, consistently leading to improvement, if not full resolution of chylothorax.
authors.affiliation: Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Ala, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Law
authors.affiliation: Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Ala, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: McMahon
authors.affiliation: Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA.
authors.forename: Kristal M
authors.initials: KM
authors.lastname: Hock
authors.affiliation: Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA.
authors.forename: Hayden J
authors.initials: HJ
authors.lastname: Zaccagni
authors.affiliation: Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA.
authors.forename: Santiago
authors.initials: S
authors.lastname: Borasino
authors.affiliation: Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alten
mesh_terms: D000407:Alabama; D000800:Angioplasty, Balloon; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002916:Chylothorax / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003251:Constriction, Pathologic; D042241:Early Diagnosis; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010690:Phlebography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014654:Vascular Patency
keywords: Balloon Vein Dilation; Chylothorax; Innominate Vein Occlusion; Venous Occlusion