title: Superior Vena Cava Reconstruction for Treatment of Chylothorax Resulting From Thrombosis of Superior Vena Cava in Young Infants.
abstract: BACKGROUND
  Thrombosis and occlusion of the superior vena cava (SVC) can cause massive chylothorax resulting in significant morbidity and mortality among young infants. Medical therapy is often unsuccessful. We report a new surgical technique that entails open thrombectomy and reconstruction of the SVC and innominate vein to treat this condition.
  
  
  METHODS
  The charts of 4 consecutive infants with chylothoraces refractory to conservative management were reviewed. The operations were performed on cardiopulmonary bypass without myocardial arrest. The SVC and innominate veins were incised open, and thrombectomy was performed. This was followed by homograft patch reconstruction of both the veins.
  
  
  RESULTS
  The infants were aged between 5 weeks to 4 months and had an average weight of 4 kg. All of them had hypoalbuminemia and evidence of hypercoagulable state. After surgical intervention, 3 had complete relief of SVC obstruction. Two of the 3 patients had complete resolution of chylous effusion, and the third patient had a significant decrease in chest tube drainage (70%) by the end of 1 week. The fourth patient had recurrence of high drainage after an initial improvement, and a subsequent angiogram demonstrated stenosis of the SVC without thrombosis. The chest tube drainage finally resolved after balloon angioplasty.
  
  
  CONCLUSIONS
  Thrombotic occlusion of the SVC can result in chylothorax that is often not amenable to medical therapy. This is associated with significant loss of proteins and hypercoagulable state. A complete surgical relief of SVC obstruction by open thrombectomy and venoplasty can result in dramatic decrease in chylous output.
authors: Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee. Electronic address: tskumar@uthsc.edu.
authors: T K Susheel
authors: TK
authors: Kumar
authors: Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee.
authors: Saradha
authors: S
authors: Subramanian
authors: Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee.
authors: Shyam
authors: S
authors: Sathanandam
authors: Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee.
authors: John
authors: J
authors: Alexander
authors: Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee.
authors: Mohammed
authors: M
authors: Ali
authors: Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee.
authors: Christopher J
authors: CJ
authors: Knott-Craig
mesh_terms: D016121:Brachiocephalic Veins / Q000601:surgery*; D002916:Chylothorax / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013479:Superior Vena Cava Syndrome / Q000150:complications*; D017131:Thrombectomy / Q000379:methods*; D014683:Vena Cava, Superior / Q000601:surgery*