The role of pleurodesis in the management of chylous pleural effusion after surgery for congenital heart disease.

This study aimed to determine the incidence and outcome of postoperative chylous pleural effusion as well as the efficacy of pleurodesis for its management after surgery for congenital heart disease. Medical and surgical databases were used to identify all patients who had surgery for congenital heart disease and subsequently experienced postoperative chylous pleural effusion. Medical records were reviewed and daily chest drainage and management strategies were recorded. From January 2000 to June 2006, 1,166 cardiac operations were followed by 19 cases of chylous pleural effusion, for an incidence of 1.6%. The diagnosis was made a mean of 9 days after the operation. The patients were divided into two groups according to treatment strategy. Group 1 included 9 patients who had received only conventional medical treatment consisting of parenteral nutrition and/or medium-chain triglyceride formula and/or a low-fat diet and/or somatostatin. Group 2 included 10 patients who initially received conventional medical treatment, then subsequently received chemical or mechanical pleurodesis. The amount of the chylous drainage was significantly less in group 1 (14 ml/kg/day) than in group 2 (24 ml/kg/day) (P < 0.05), suggesting a more severe problem in group 2. For group 2, the amount of drainage was significantly less after chemical or mechanical pleurodesis (8 vs 24 ml/kg/day; P < 0.05) than before. Seven patients (70%) responded favorably to the first pleurodesis, and two patients (20%) required more than one pleurodesis. One patient (10%) did not respond to pleurodesis but was treated successfully with thoracic duct ligation. There were no deaths. Pleurodesis is a safe and effective method for treating chylous effusion after surgical treatment of congenital heart disease, especially after failed conservative treatment. However, some patients may need more than one pleurodesis.