Diagnosis and Management of Chylothorax in Children after Congenital Heart Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUOYu-xiong ¹ ,  HEShao-ru ² , ZHONGMin-quan ¹ , LIANGSui-xin ² , SUNYue-yu ¹ , CHENJi-mei ³ , ZHUANGJian ³

1. Department of Paediatric Intensive Care Unit, Guangdong General Hospital, Guangdong Academic of Medical Science, Guangzhou 510080, P. R. China;
2. Department of Neonatology, Guangdong General Hospital, Guangdong Academic of Medical Science, Guangzhou 510080, P. R. China;
3. Department of Paediatric Cardiac Surgery, Guangdong General Hospital, Guangdong Academic of Medical Science, Guangdong Provincial Cardiovascular Institute, Guangzhou 510080, P. R. China;

Corresponding author：

HEShao-ru, Email: hsr1065@126.com

Keywords：

Chylothorax; Children; Congenital heart disease; Cardiac surgery

DOI：

10.7507/1007-4848.20150184

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Objective To investigate the clinical characteristics, diagnosis and management of postoperative chylothorax after congenital cardiac surgery in infants and children. Methods We retrospectively analyzed clinical data of 79 postoperative patients with chylothorax after congenital cardiac surgery in Guangdong General Hospital between January 2006 and December 2013.There were 54 males and 25 females at age ranged 8 days to 14 years. Results The prevalence of postoperative chylothorax was 0.6% (79/12 067). A total of 75 (94.9%) patients were cured. And 71 patients (89.9%) were cured by conservative treatment. While 4(5.1%) patients received operative treatment, including 3 patients undergoing ligation of thoracic duct, 1 patient undergoing lymphatic ablation. There were 4 (5.1%) patients failed to treat, including 1(1.3%) abandoned, 3 (mortality of 3.8%) deaths in hospital for low cardiac output syndrome, cardiac arrest and severe anastomotic stenosis after transposition of conducting arteries(TGA), tetralogy of Fallot(TOF) and total anomalous pulmonary venous connection(TAPVC) operation respectively. Hospitalization time ranged 10 to 108 (39.3±19.4) d. There was no recurrence of chylothorax within 6 months to 8 years of following-up. Conclusion The key to prevention of chylothorax is to improve the surgical technology. Conservative management of chylothorax will be successful in most cases, but surgical treatment ought to be considered if the conservative management is unsuccessful.

Citation： GUOYu-xiong, HEShao-ru, ZHONGMin-quan, LIANGSui-xin, SUNYue-yu, CHENJi-mei, ZHUANGJian. Diagnosis and Management of Chylothorax in Children after Congenital Heart Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(8): 734-738. doi: 10.7507/1007-4848.20150184 Copy

1.	Le Coultre C, Oberhansli I, Mossaz A, et al. Postoperative chylothorax in children:Differences between vascular and traumatic origin. J Pediatr Surg, 1991, 26(5):519-523.
2.	Bond SJ, Guzzetta PC, Snyder ML, et al. Management of pediatric postoperative chylothorax. Ann Thorac Surg, 1993, 56(3):469-472.
3.	Haines C, Walsh B, Fletcher M, et al. Chylothorax development in infants and children in the UK. Arch Dis Child, 2014, 99(8):724-730.
4.	Sassoon CS, Light RW. Chylothorax and pseudochylothorax. Clin Chest Med, 1985, 6(1):163-171.
5.	Shah RD, Luketich JD, Schuchert MJ, et al. Postesophagectomy chylothorax:Incidence, risk factors and outcome. Ann Thorac Surg, 2012, 93(3):897-903.
6.	Mery CM, Moffett BS, Khan MS, et al. Incidence and treatment of chylothorax after cardiac surgery in children:analysis of a large multi-institutiondatabase. J Thorac Cardiovasc Surg, 2014, 147(2):678-686.
7.	Wu JM, Yao CT, Kan CD, et al. Postoperative chylothorax:differences between patients who received median sternotomy or lateral thoracotomyfor congenital heart disease. J Card Surg, 2006, 21(3):249-253.
8.	付雪梅, 巨容. 新生儿乳糜胸的诊治策略. 实用儿科临床杂志, 2010, 25(14):1040-1042.
9.	Ilczyszyn A, Ridha H, Durrani AJ. Management of chyle leak post neck dissection:a case report and literature review. J Plast Reconstr Aesthet Surg, 2011, 64(9):223-230.
10.	Allen EM, Van Heeckeren DW, Spector ML, et al. Management of nutritional and infectious complications of postoperative chylothorax in children. J Pediatr Surg, 1991, 26(10):1169-1174.
11.	Breaux JR, Marks C. Chylothorax causing reversible T-cell depletion. J Trauma, 1988, 28(5):705-707.
12.	McCulloch MA, Conaway MR, Haizlip JA, et al. Postoperative chylothorax development is associated with increased incidence and risk profile for central venous thromboses. Pediatr Cardial, 2008, 29(3):556-561.
13.	Eicken A, Genz T, Wild F, et al. Resolution of persistent late postoperative chylothorax after coil occlusion of aortopulmonary collaterals. Int J Cardiol, 2007, l15(2):e80-82.
14.	Wemyss-Holden SA, Launois B, Maddern GJ. Management of thoracic duct injuries after oesophagectomy. Br J Surg, 2001, 88(11):1442-1448.
15.	McGrath EE, Blades Z, Anderson PB. Chylothorax:aetiology, diagnosis and therapeutic options. Respir Med, 2010, 104(1):1-8.
16.	孙宏涛, 孙立忠, 阎军, 等. 经胸骨正中切口心脏手术后并发乳糜胸的治疗. 中国胸心血管外科临床杂志, 2010, 17(2):163-164.
17.	宓亚平, 贾兵, 李圻, 等. 先天性心脏病术后乳糜胸 36例. 实用儿科临床志, 2009, 24(1):70-72.
18.	Biewer ES, Zurn C, Arnold R, et al. Chylothorax after surgery on congenital heart disease in newborns and infants-risk factors and efficacy of MCT-diet. J Cardiothorac Surg, 2010, 13(5):127.
19.	Beghetti M, La Scala G, Belli D, et al. Etiology and management of pediatric chylothorax. J Pediatr, 2000, 136(5):653-658.
20.	Nakabayashi H, Sagara H, Usukura N, et al. Effect of somatostatin on the flow rate and triglyceride levels of thoracic duct lymph in normal and vagotomized dogs. Diabetes, 1981, 30(5):440-445.
21.	Rimensberger PC, Müller-Schenker B, Kalangos A, et al. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg, 1998, 66(1):253-254.
22.	Caverly L, Rausch CM, da Cruz E, et al. Octreotide treatment of chylothorax in pediatric patients following cardiothoracic surgery. Congenit Heart Dis, 2010, 5(6):573-578.
23.	Chen Y, Li C, Xu L, et al. Novel treatment for chylothorax after esophagectomy with 50% glucose pleurodesis. Ann Vasc Surg, 2010, 24(5):694.e9-13.
24.	Brissaud O, Desfrere L, Mohsen R, et al. Congenital idiopathic chylothorax in neonates:chemical pleurodesis with povidoneiodine. Arch Dis Child Fetal Neonatal Ed, 2003, 88(6):531-533.
25.	Murki S, Faheemuddin M, Gaddam P. Congenital chylothoraxsuccessful management with chemical pleurodesis. Indian J Pediatr, 2010, 77(3):332-334.
26.	Arayici S, Simsek GK, Oncel MY, et al. Povidone-iodine for persistent air leak in an extremely low birth weight infant. J Pediatr Surg, 2013, 48(5):E21-23.
27.	Rodriguez-Panadero F, Montes-Worboys A. Mechanisms of pleurodesis. Respiration, 2012, 83(2):91-98.
28.	Burgers JA, Kunst PW, Koolen MG, et al. Pleural drainage and pleurodesis:implementation of guidelines in four hospitals. Eur Respir J, 2008, 32(5):1321-1327.
29.	Soto-Martinez M, Massie J. Chylothorax:diagnosis and management in children. Paediatr Respir Rev, 2009, 10(4):199-207.
30.	Nath DS, Savla J, Khemani RG, et al. Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery. Ann Thorac Surg, 2009, 88(1):246-251.

1. Le Coultre C, Oberhansli I, Mossaz A, et al. Postoperative chylothorax in children:Differences between vascular and traumatic origin. J Pediatr Surg, 1991, 26(5):519-523.
2. Bond SJ, Guzzetta PC, Snyder ML, et al. Management of pediatric postoperative chylothorax. Ann Thorac Surg, 1993, 56(3):469-472.
3. Haines C, Walsh B, Fletcher M, et al. Chylothorax development in infants and children in the UK. Arch Dis Child, 2014, 99(8):724-730.
4. Sassoon CS, Light RW. Chylothorax and pseudochylothorax. Clin Chest Med, 1985, 6(1):163-171.
5. Shah RD, Luketich JD, Schuchert MJ, et al. Postesophagectomy chylothorax:Incidence, risk factors and outcome. Ann Thorac Surg, 2012, 93(3):897-903.
6. Mery CM, Moffett BS, Khan MS, et al. Incidence and treatment of chylothorax after cardiac surgery in children:analysis of a large multi-institutiondatabase. J Thorac Cardiovasc Surg, 2014, 147(2):678-686.
7. Wu JM, Yao CT, Kan CD, et al. Postoperative chylothorax:differences between patients who received median sternotomy or lateral thoracotomyfor congenital heart disease. J Card Surg, 2006, 21(3):249-253.
8. 付雪梅, 巨容. 新生儿乳糜胸的诊治策略. 实用儿科临床杂志, 2010, 25(14):1040-1042.
9. Ilczyszyn A, Ridha H, Durrani AJ. Management of chyle leak post neck dissection:a case report and literature review. J Plast Reconstr Aesthet Surg, 2011, 64(9):223-230.
10. Allen EM, Van Heeckeren DW, Spector ML, et al. Management of nutritional and infectious complications of postoperative chylothorax in children. J Pediatr Surg, 1991, 26(10):1169-1174.
11. Breaux JR, Marks C. Chylothorax causing reversible T-cell depletion. J Trauma, 1988, 28(5):705-707.
12. McCulloch MA, Conaway MR, Haizlip JA, et al. Postoperative chylothorax development is associated with increased incidence and risk profile for central venous thromboses. Pediatr Cardial, 2008, 29(3):556-561.
13. Eicken A, Genz T, Wild F, et al. Resolution of persistent late postoperative chylothorax after coil occlusion of aortopulmonary collaterals. Int J Cardiol, 2007, l15(2):e80-82.
14. Wemyss-Holden SA, Launois B, Maddern GJ. Management of thoracic duct injuries after oesophagectomy. Br J Surg, 2001, 88(11):1442-1448.
15. McGrath EE, Blades Z, Anderson PB. Chylothorax:aetiology, diagnosis and therapeutic options. Respir Med, 2010, 104(1):1-8.
16. 孙宏涛, 孙立忠, 阎军, 等. 经胸骨正中切口心脏手术后并发乳糜胸的治疗. 中国胸心血管外科临床杂志, 2010, 17(2):163-164.
17. 宓亚平, 贾兵, 李圻, 等. 先天性心脏病术后乳糜胸 36例. 实用儿科临床志, 2009, 24(1):70-72.
18. Biewer ES, Zurn C, Arnold R, et al. Chylothorax after surgery on congenital heart disease in newborns and infants-risk factors and efficacy of MCT-diet. J Cardiothorac Surg, 2010, 13(5):127.
19. Beghetti M, La Scala G, Belli D, et al. Etiology and management of pediatric chylothorax. J Pediatr, 2000, 136(5):653-658.
20. Nakabayashi H, Sagara H, Usukura N, et al. Effect of somatostatin on the flow rate and triglyceride levels of thoracic duct lymph in normal and vagotomized dogs. Diabetes, 1981, 30(5):440-445.
21. Rimensberger PC, Müller-Schenker B, Kalangos A, et al. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg, 1998, 66(1):253-254.
22. Caverly L, Rausch CM, da Cruz E, et al. Octreotide treatment of chylothorax in pediatric patients following cardiothoracic surgery. Congenit Heart Dis, 2010, 5(6):573-578.
23. Chen Y, Li C, Xu L, et al. Novel treatment for chylothorax after esophagectomy with 50% glucose pleurodesis. Ann Vasc Surg, 2010, 24(5):694.e9-13.
24. Brissaud O, Desfrere L, Mohsen R, et al. Congenital idiopathic chylothorax in neonates:chemical pleurodesis with povidoneiodine. Arch Dis Child Fetal Neonatal Ed, 2003, 88(6):531-533.
25. Murki S, Faheemuddin M, Gaddam P. Congenital chylothoraxsuccessful management with chemical pleurodesis. Indian J Pediatr, 2010, 77(3):332-334.
26. Arayici S, Simsek GK, Oncel MY, et al. Povidone-iodine for persistent air leak in an extremely low birth weight infant. J Pediatr Surg, 2013, 48(5):E21-23.
27. Rodriguez-Panadero F, Montes-Worboys A. Mechanisms of pleurodesis. Respiration, 2012, 83(2):91-98.
28. Burgers JA, Kunst PW, Koolen MG, et al. Pleural drainage and pleurodesis:implementation of guidelines in four hospitals. Eur Respir J, 2008, 32(5):1321-1327.
29. Soto-Martinez M, Massie J. Chylothorax:diagnosis and management in children. Paediatr Respir Rev, 2009, 10(4):199-207.
30. Nath DS, Savla J, Khemani RG, et al. Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery. Ann Thorac Surg, 2009, 88(1):246-251.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnosis and Management of Chylothorax in Children after Congenital Heart Surgery

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