Doğan Kahraman1, Gökhan Keskin2, Emced Khalil3, Omer Faruk Dogan4. 1. Department of Cardiovascular Surgery, Gaziantep University School of Medicine, Gaziantep, Turkey. 2. Department of Cardiology, Amasya University School of Medicine, Amasya, Turkey. 3. Department of Cardiovascular Surgery, Ordu University Research and Training Hospital, Ordu, Turkey. 4. Department of Cardiovascular Surgery, Kafkas University School of Medicine, Kars, Turkey.
Abstract
BACKGROUND: Chylothorax or pseudo-chylothorax is a serious complication after adult and pediatric cardiac surgery. This study presents our 10-year clinical experience of chylothorax after cardiac surgery. METHODS: Between January 2008 and February 2019, 4896 cardiovascular surgeries were performed in 2 tertiary clinics, with 416 patients in the pediatric age group (8.4%). Chylothorax and pseudo-chylothorax were detected in 47 patients (22 adult and 20 pediatric patients, 4.8%). Pseudo-chylothorax was seen in 5 adult patients. In 27 patients, a pleural effusion developed on the left side (64.2%). Quantities of chylomicron in pleural effusion were significant in all patients. In addition, protein and lactate dehydrogenase levels were >2.9 g/dL. The cholesterol level in the pleural effusion was >2.49 mmol/L in all patients. The mean latency period was 8 days (range 3.1 to 63.1). For the management of chylothorax, somatostatin or octreotide as a somatostatin analog was administered in 23 patients (15 adult and 8 pediatric) in the intensive care unit. Somatostatin or octreotide was administered intravenously or subcutaneously at a dose of 0.3 to 4 µg/(kg · h-1). We used dexamethasone as a steroid combined with somatostatin in patients who were resistant to medical treatment before pleurodesis or ductus closure. Classic chemical pleurodesis combined with fibrin glue was performed in 11 patients (8 adult and 3 pediatric). Surgical duct ligation, as the last option, was performed in 7 patients. RESULTS: No mortality or morbidity was observed. Chylothorax improved with the medical approach in 23 patients within 24.2 ± 11.3 days (48.9%). We successfully performed the pleurodesis procedure using fibrin glue in addition to the classic method. The mean duration of conservative treatment was 27.1 days (range 11 to 39). After discharge from the hospital, 2 children had recurrence of chylothorax, and the ductus thoracicus was surgically ligated. No complication was seen during or after ductus ligation. CONCLUSIONS: According to our clinical experience, chylothorax is not an extremely rare complication after cardiac surgery in pediatric cardiovascular surgery. A number of patients with chylothorax may be treated medically and with diet adjustment. Medical treatment including steroid administration may be the first treatment strategy immediately after diagnosis. Classic chemical pleurodesis combined with fibrin glue may be applied in the early stages. Surgical ligation of the ductus thoracicus should be considered the last treatment option.
BACKGROUND: Chylothorax or pseudo-chylothorax is a serious complication after adult and pediatric cardiac surgery. This study presents our 10-year clinical experience of chylothorax after cardiac surgery. METHODS: Between January 2008 and February 2019, 4896 cardiovascular surgeries were performed in 2 tertiary clinics, with 416 patients in the pediatric age group (8.4%). Chylothorax and pseudo-chylothorax were detected in 47 patients (22 adult and 20 pediatric patients, 4.8%). Pseudo-chylothorax was seen in 5 adult patients. In 27 patients, a pleural effusion developed on the left side (64.2%). Quantities of chylomicron in pleural effusion were significant in all patients. In addition, protein and lactate dehydrogenase levels were >2.9 g/dL. The cholesterol level in the pleural effusion was >2.49 mmol/L in all patients. The mean latency period was 8 days (range 3.1 to 63.1). For the management of chylothorax, somatostatin or octreotide as a somatostatin analog was administered in 23 patients (15 adult and 8 pediatric) in the intensive care unit. Somatostatin or octreotide was administered intravenously or subcutaneously at a dose of 0.3 to 4 µg/(kg · h-1). We used dexamethasone as a steroid combined with somatostatin in patients who were resistant to medical treatment before pleurodesis or ductus closure. Classic chemical pleurodesis combined with fibrin glue was performed in 11 patients (8 adult and 3 pediatric). Surgical duct ligation, as the last option, was performed in 7 patients. RESULTS: No mortality or morbidity was observed. Chylothorax improved with the medical approach in 23 patients within 24.2 ± 11.3 days (48.9%). We successfully performed the pleurodesis procedure using fibrin glue in addition to the classic method. The mean duration of conservative treatment was 27.1 days (range 11 to 39). After discharge from the hospital, 2 children had recurrence of chylothorax, and the ductus thoracicus was surgically ligated. No complication was seen during or after ductus ligation. CONCLUSIONS: According to our clinical experience, chylothorax is not an extremely rare complication after cardiac surgery in pediatric cardiovascular surgery. A number of patients with chylothorax may be treated medically and with diet adjustment. Medical treatment including steroid administration may be the first treatment strategy immediately after diagnosis. Classic chemical pleurodesis combined with fibrin glue may be applied in the early stages. Surgical ligation of the ductus thoracicus should be considered the last treatment option.