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Saad D, Makarem A, Fakhri G, Al Amin F, Bitar F, El Rassi I, Arabi M. The use of steroids in treating chylothorax following cardiac surgery in children: a unique perspective. Cardiol Young 2022; 32:1-6. [PMID: 35361290 DOI: 10.1017/s1047951122000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chylothorax is the accumulation of chyle fluid in the pleural space. The incidence of chylothorax is quite common post-cardiac surgeries in pediatrics especially in Fontan procedures. Although several treatment lines are known for the management of chylothorax, steroids were scarcely reported as a treatment option. We present a unique case of a 4-year-old child who underwent Fontan procedure and suffered a long-term consequence of chylothorax. The chylothorax only fully resolved after introducing corticosteroids as part of her management. METHODS A literature review about management of chylothorax post-cardiac surgery in children using Ovid Medline (19462021), PubMed, and google scholar was performed. CONCLUSION Conservative management without additional surgical intervention is adequate in most patients. Additionally, somatostatin can be used with variable success rate. However, a few cases mentioned using steroids in such cases. More research and reporting on the use of steroids in the treatment of chylothorax post-cardiac surgeries in children is needed to prove its effectivity. In this article, we describe a case of chylothorax post-Fontan procedure that supports the use of steroids.
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Affiliation(s)
- Dima Saad
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Adham Makarem
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghina Fakhri
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Farah Al Amin
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Issam El Rassi
- Department of Cardiothoracic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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2
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Rocha G, Arnet V, Soares P, Gomes AC, Costa S, Guerra P, Casanova J, Azevedo I. Chylothorax in the neonate-A stepwise approach algorithm. Pediatr Pulmonol 2021; 56:3093-3105. [PMID: 34324269 DOI: 10.1002/ppul.25601] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chylothorax in neonates results from leakage of lymph from thoracic lymphatic ducts and is mainly congenital or posttraumatic. The clinical course of the effusion is heterogeneous, and consensus on treatment, timing, and modalities of measures has not yet been established. This review aims to present, along with levels of evidence and recommendation grades, all current therapeutic possibilities for the treatment of chylothorax in neonates. METHODS An extensive search of publications between 1970 and 2020 was performed in the PubMed, Cochrane Database of Systematic Reviews, and UpToDate databases. A stepwise approach algorithm was proposed for both congenital and traumatic conditions to guide the clinician in a rational and systematic way for approaching the treatment of neonates with chylothorax. DISCUSSION AND CONCLUSION The treatment strategy for neonatal chylothorax generally involves supportive care and includes drainage and procedures to reduce chyle flow. A stepwise approach starting with the least invasive method is advocated. Progression in the invasiveness of treatment options is determined by the response to previous treatments. A practical stepwise approach algorithm is proposed for both, congenital and traumatic chylothoraces.
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Affiliation(s)
- Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Vanessa Arnet
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paulo Soares
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Ana Cristina Gomes
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Sandra Costa
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Paula Guerra
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal.,Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Casanova
- Department of Cardiothoracic Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Inês Azevedo
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal.,Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal.,EPIUnit, Public Health Institution, University of Porto, Porto, Portugal
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3
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Resch B, Sever Yildiz G, Reiterer F. Congenital Chylothorax of the Newborn: A Systematic Analysis of Published Cases between 1990 and 2018. Respiration 2021; 101:84-96. [PMID: 34515211 DOI: 10.1159/000518217] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Congenital chylothorax (CCT) of the newborn is a rare entity but the most common cause of pleural effusion in this age-group. We aimed to find the optimal treatment strategy. MATERIAL AND METHODS A PubMed search was performed according to the PRISMA criteria. All cases were analyzed according to prenatal, perinatal, and postnatal treatment modalities and follow-ups. RESULTS We identified 753 cases from 157 studies published between 1990 and 2018. The all-cause mortality rate was 28%. Prematurity was present in 71%, male gender dominated 57%, mean gestational age was 34 weeks, and birth weight was 2,654 g. Seventy-nine percent of newborns had bilateral CCT, the most common associated congenital anomalies with CCT were pulmonary lymphangiectasia and pulmonary hypoplasia, and the most common chromosomal aberrations were Down, Noonan, and Turner syndromes, respectively. Mechanical ventilation was reported in 381 cases for mean 17 (range 1-120) days; pleural punctuations and drainages were performed in 32% and 64%, respectively. Forty-four percent received total parenteral nutrition (TPN) for mean 21 days, 46% medium-chain triglyceride (MCT) diet for mean 37 days, 20% octreotide, and 3% somatostatin; chemical pleurodesis was performed in 116 cases, and surgery was reported in 48 cases with a success rate of 69%. In 462 cases (68%), complete restitution was reported; in 34 of 44 cases (77%), intrauterine intervention was carried out. CONCLUSION Respiratory support, pleural drainages, TPN, and MCT diet as octreotide remain to be the cornerstones of CCT management. Pleurodesis with OK-432 done prenatally and povidone-iodine postnatally might be discussed for use in life-threatening CCT.
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Affiliation(s)
- Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Gülsen Sever Yildiz
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Friedrich Reiterer
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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4
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Elassal AA, Al-Radi OO, Dohain AM, Abdelmohsen GA, Al-Ebrahim KE, Eldib OS. Excess nonhemorrhagic pleural drainage after surgery for congenital heart diseases: Single center experience. J Card Surg 2019; 35:108-112. [PMID: 31730717 DOI: 10.1111/jocs.14338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Chylothorax after surgery for congenital heart disease is an uncommon but serious complication that adversely affects surgical outcomes. The aim of our study was presenting our experience for the management of postoperative chylothorax and excess nonhemorrhagic pleural drainage. METHODS Medical records of patients with excess nonhemorrhagic pleural drainage were retrospectively reviewed and the collected data included demographics, surgical procedures, drainage characteristics, methods of postoperative management, and outcome. RESULTS From March 2011 to May 2018, 52 patients with excess postoperative pleural drainage were identified from a total of 816 pediatric patients operated upon for congenital cardiac disease, giving an incidence of 63.7%. Tetralogy of Fallot and single ventricle morphology were the most common cardiac pathology. The serum triglyceride level was checked and found elevated in 30 patients (53.5%). The maximum daily drainage was 136.25 ± 109.7 mL/day and the mean duration of drainage was 32.23 ± 35.7 days. Medium-chain triglyceride formula was given for 27 patients (51.9%), octreotide for 22 (42.3%) for a mean duration of 8.07 ± 28.3 days. Total parenteral nutrition was needed for 11 patients (21.1%) for a mean duration of 3.13 ± 7.63 days. The success rate for conservative management was 94.2%. Thoracic duct ligation performed for three patients. The mean duration of mechanical ventilation was 7.4 ± 3.6 days, mean intensive care unit stay was 29.6 ± 35.1 days, and mean total hospital stay was 20.9 ± 17.5 days. We had six cases of hospital mortality (11.53%). CONCLUSION Initiation of a stepwise approach for excess nonhemorrhagic pleural drainage based on the amount and rate of drainage achieve a favorable outcomes.
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Affiliation(s)
- Ahmed A Elassal
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Osman O Al-Radi
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ahmed M Dohain
- Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt.,Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Gaser A Abdelmohsen
- Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt.,Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Khalid E Al-Ebrahim
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Osama S Eldib
- Department of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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5
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Hayashida K, Yamakawa S, Shirakami E. Lymphovenous anastomosis for the treatment of persistent congenital chylothorax in a low-birth-weight infant: A case report. Medicine (Baltimore) 2019; 98:e17575. [PMID: 31651860 PMCID: PMC6824808 DOI: 10.1097/md.0000000000017575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Chylothorax remains a poorly understood phenomenon, and no optimal treatment or guidelines have been established. This is the first report of treating congenital chylothorax and lymphedema in a low-birth-weight infant by lymphovenous anastomosis (LVA). PATIENT CONCERNS We report a case of successful LVA for persistent congenital chylothorax and lymphedema resistant to other conservative therapies. DIAGNOSIS The diagnosis of chylothorax was confirmed by the predominance of lymphocytes in the pleural fluid draining from the chest tube. In addition, the infant developed oliguria and generalized lymphedema. INTERVENTIONS LVA under local anesthesia combined with light sedation was performed at his medial thighs and left upper arm. OUTCOMES Although his subcutaneous edema markedly improved, the decrease in chest tube drainage was gradual. No additional treatment was required. LESSONS LVA is of considerable value as a surgical treatment option in the setting of persistent congenital chylothorax and lymphedema, because LVA is a less invasive procedure.
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6
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Srinivasa RN, Chick JFB, Gemmete JJ, Hage AN, Srinivasa RN. Endolymphatic Interventions for the Treatment of Chylothorax and Chylous Ascites in Neonates: Technical and Clinical Success and Complications. Ann Vasc Surg 2018. [PMID: 29524461 DOI: 10.1016/j.avsg.2018.01.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to report the technical and clinical success of performing minimally invasive endolymphatic embolization in neonates presenting with a chylothorax or chylous ascites. METHODS Three neonates, 2 males and 1 female, with a mean age of 28 days (range: 19-39 days) presented with a chylothorax or chylous ascites that was refractory to conservative management. All 3 patients (1 previously reported) underwent intranodal lymphangiography, followed by thoracic duct embolization, with 1 patient undergoing additional sclerosis of the retroperitoneal abdominal lymphatics. RESULTS Lymphangiography, thoracic duct embolization, and sclerosis of the retroperitoneal abdominal lymphatics were technically successful. The chylothorax resolved in both the patients. Persistent chylous ascites was noted after treatment which resolved after surgical placement of a vicryl mesh and fibrin sealant. One major complication occurred with nontarget embolization of glue into the lungs requiring embolectomy. CONCLUSIONS Thoracic duct and retroperitoneal abdominal lymphatic embolization can be performed in neonates. Resolution of chylothorax was seen in 2 patients (one previously reported) after embolization, whereas 1 patient with chylous ascites required surgical management after endolymphatic intervention.
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Affiliation(s)
- Rajiv N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Joseph J Gemmete
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Anthony N Hage
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, Ann Arbor, MI.
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7
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Spiwak E, Wiesenauer C, Panigrahi A, Raj A. Use of Pleuroperitoneal Shunt in Chylothorax Related to Central Line Associated Thrombosis in Sickle Cell Disease. CHILDREN-BASEL 2018; 5:children5010007. [PMID: 29301288 PMCID: PMC5789289 DOI: 10.3390/children5010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 11/16/2022]
Abstract
Central vein thrombosis as a cause of chylothorax is uncommon, and in a few cases in the literature was related to thrombotic complications of central venous access devices (CVAD). Superior vena cava (SVC) occlusion-induced chylothorax has been described in adult sickle cell disease (SCD) in a setting of chronic indwelling CVAD. There are limited reports on chylothorax induced by central venous thrombosis secondary to chronic CVAD in children with SCD. We describe an 8-year-old male patient, with a history of SCD, maintained on long term erythrocytapheresis for primary prevention of stroke, and whose clinical course was complicated by chylothorax which was successfully treated with a pleuroperitoneal shunt.
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Affiliation(s)
- Elizabeth Spiwak
- Department of Pediatrics, University of Louisecille, Louisville, KY 40202, USA.
| | - Chad Wiesenauer
- Department of Pediatric Surgery, University of Louisville, Louisville, KY 40202, USA.
| | - Arun Panigrahi
- Department of Pediatric Hematology-Oncology, UC Davis, University of California, Sacramento, CA 95817, USA.
| | - Ashok Raj
- Department of Pediatric Hematology-Oncology, University of Louisville, Louisville, KY 40206, USA.
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8
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Gómez-Caro AA, Moradiellos Diez FJ, Marrón CF, Larrú Cabrero EJ, Martín de Nicolás JL. Conservative Management of Postsurgical Chylothorax with Octreotide. Asian Cardiovasc Thorac Ann 2016; 13:222-4. [PMID: 16112992 DOI: 10.1177/021849230501300306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postsurgical chylothorax after lung resection has an important associated rate of morbidity and mortality, and a large proportion of cases require re-exploration. The most desirable and least aggressive option is conservative treatment. The use of octreotide seems to be associated with a higher rate of resolution without the need for surgical intervention. We present 4 cases in which this drug showed excellent efficacy and minimal adverse effects in the resolution of postsurgical chylothorax.
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Affiliation(s)
- Abel A Gómez-Caro
- Department of Thoracic Surgery, 12 de Octubre University Hospital, Andalucía Ctra KM 5.400, Madrid 28004, Spain.
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9
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Talwar S, Das A, Choudhary SK, Airan B. Diaphragmatic Fenestration for Resistant Pleural Effusions After Univentricular Palliation. World J Pediatr Congenit Heart Surg 2016; 7:146-51. [DOI: 10.1177/2150135115627651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Persistent pleural effusions are a major source of morbidity after univentricular repair. These are often refractory to conventional conservative therapy. We adopted a strategy of diaphragmatic fenestration (DF) in such patients and report the results. Methods: Between January 2002 and 2014, we performed DF in 12 patients using an original technique that was first described by us. The medical records of all these patients were studied. Preoperative characteristics, amount and duration of effusions, and time to removal of chest tubes following DF were studied. Results: Mean age was 101 ± 57.9 months (range: 38-180 months), and mean body weight was 18.8 ± 5.8 kg (range: 11-28 kg). Five had a bidirectional Glenn, four had lateral tunnel Fontan, and three had an extracardiac Fontan as initial procedure. The average pleural drainage prior to DF was 352.5 ± 152 mL/24 h (18.75 mL/kg/24 h) for a median period of 33 days (bidirectional Glenn 216 ± 85 mL/24 h [16.5 mL/kg/24 h] for 30 days and total cavopulmonary connection 450 ± 104 mL/24 h [22.5 mL/kg/24 h] for 36 days). All patients underwent DF. Additionally, five patients underwent thoracic duct ligation on the left side. Postoperative chest drainage after DF was 25 mL/d for a median of 4 days, and the chest tubes could be removed in a median of 5.5 days (mean 7 days). There were no complications related to DF. Conclusions: In patients with persistent pleural effusions following univentricular palliation, DF is an attractive option when conventional therapies have failed. This original technique of DF is simple, reproducible, cost-effective, and free of any known complications.
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Affiliation(s)
- Sachin Talwar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Das
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Airan
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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10
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Scottoni F, Fusaro F, Conforti A, Morini F, Bagolan P. Pleurodesis with povidone-iodine for refractory chylothorax in newborns: Personal experience and literature review. J Pediatr Surg 2015; 50:1722-5. [PMID: 25969129 DOI: 10.1016/j.jpedsurg.2015.03.069] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/03/2015] [Accepted: 03/31/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Refractory chylothorax is a severe clinical issue, particularly in neonates. Conventional primary approach is based on diet with medium-chain fatty acids and/or total parenteral nutrition. In nonresponders, proposed second line treatments include chemical or surgical pleurodesis, thoracic duct ligation, pleuroperitoneal shunting and pleurectomy but none of these have been shown to be superior to other in terms of resolution rate and safety. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment. METHODS Since 2013, povidone-iodine pleurodesis was attempted in all patients with persistent chylothorax who failed conservative treatment (no response to at least 10 days of total parenteral nutrition and maximum dosage of intravenous octreotide). Pleurodesis consisted in the injection of 2 ml/kg of a 4% povidone-iodine solution inside the pleural space, leaving the pleural tube clamped for the subsequent 4 hours. RESULTS Five patients were treated with chemical pleurodesis of persistent chylothorax. Four of 5 patients had their pleural effusion treated by one single povidone-iodine infusion. Median time for resolution was 4 days. A patient with massive superior vena cava thrombosis did not benefit from pleurodesis. None of the patients experienced long term side effects of the treatment. CONCLUSION Our data suggest that povidone-iodine pleurodesis may be considered a safe and effective option to treat refractory chylothorax in newborns.
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Affiliation(s)
- Federico Scottoni
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Fabio Fusaro
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Conforti
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Morini
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
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Abstract
Leakage of lymph from the lymphatic ducts causes chylothorax (CT) or chylous ascitis (CA). This may happen for unknown reasons during fetal life or after birth and may also be caused by trauma after thoracic surgery or by other conditions. Fetal CT and CA may be lethal particularly in cases with fetal hydrops that sometimes benefit of intra-uterine instrumentation. After birth, symptoms are related to the amount of accumulated fluid. Sometimes, severe cardio-respiratory compromise prompts active therapy. Most patients with CT or CA benefit from observation, rest, and supportive measures alone. Drainage of the fluid may be necessary, but then loss of protein, fat, and lymphoid cells introduce new risks and require careful replacement. Low-fat diets with MCT and parenteral nutrition decrease fluid production while allowing adequate nutritional input. If lymph leakage does not stop, secretion inhibitors like somatostatin or octreotide are prescribed, although there is only weak evidence of their benefits. Imaging of the lymphatic system is indicated when the leaks persist, but this is technically demanding in children. Shunting of the lymph from one body space to another by means of valved catheters, embolization of the thoracic duct, and/or ligation of the major lymphatics may occasionally be indicated in cases refractory to all other treatments.
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Affiliation(s)
- Juan C Lopez-Gutierrez
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; Department of Pediatrics, Universidad Autonoma de Madrid, Madrid, Spain
| | - Juan A Tovar
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; Department of Pediatrics, Universidad Autonoma de Madrid, Madrid, Spain.
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12
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Abstract
Chylothorax, the accumulation of chyle in the pleural space, is a relatively rare cause of pleural effusion in children. It can cause significant respiratory morbidity, as well as lead to malnutrition and immunodeficiency. Thus, a chylothorax requires timely diagnosis and treatment. This review will first discuss the anatomy and physiology of the lymphatic system and discuss various causes that can lead to development of a chylothorax in infants and children. Then, methods of diagnosis and treatment will be reviewed. Finally, complications of chylothorax will be reviewed.
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center; Le Bonheur Children's Hospital; and St. Jude Children's Research Hospital, Memphis, Tennessee
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13
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Shiraga K, Terui K, Ishihara K, Shibuya K, Saito E, Ito K, Hiramoto R. Pleuroperitoneal shunt for refractory chylothorax accompanied with a mediastinal lymphangioma: a case report. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:654-8. [PMID: 24088913 DOI: 10.5761/atcs.cr.12-02244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 21-month-old Japanese boy was admitted with cough and hypoxemia. Chest X-ray showed massive right pleural effusion, which consisted of chyle. Computed tomography showed poor contrast area at superior and anterior mediastinum. Magnetic resonance imaging showed granular T2-low area at the same area. Lymphangioscintigraphy revealed a hot spot at superior mediastinum. These findings lead us to diagnose as mediastinal lymphangioma accompanied with chylothorax. Noninvasive treatments including total parenteral nutrition, administration of octreotide and sclerotherapy were tried, but all of them proved to be ineffective. Transfusions of blood products were frequently needed during these therapies. On the 48th hospital day, the mediastinal tumor and the thymus were excised through a median sternotomy. A leakage point of lymph into the intrathoracic space was not found, in spite of preoperative administration of milk with dye. Since the pleural effusion had continued to be drained, pleuroperitoneal shunt was placed on the 90th hospital day. The shunting amount continued to decline soon after the shunting, and had been under 10 ml/day since the 142nd day. The shunt was removed on the 148th day. There has been no reaccumulation of the pleural effusion and no recurrence of the mediastinal tumor for 1 year of observation.
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Affiliation(s)
- Kazuhiro Shiraga
- Department of Pediatrics, Matsudo City Hospital Children's Medical Centre, Matsudo, Chiba, Japan
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14
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15
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Itkin M, Krishnamurthy G, Naim MY, Bird GL, Keller MS. Percutaneous thoracic duct embolization as a treatment for intrathoracic chyle leaks in infants. Pediatrics 2011; 128:e237-41. [PMID: 21646254 DOI: 10.1542/peds.2010-2016] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Chylothorax is an uncommon complication of cardiothoracic surgery in children that is traditionally treated with either conservative (diet modification, octreotide administration, and percutaneous drainage) or surgical (thoracic duct ligation, pleurodesis, and pleuroperitoneal shunt) approaches. We report here the cases of 2 children (a 6-month-old and a 1-month-old) with postoperative chylous leaks who were treated successfully by percutaneous thoracic duct embolization.
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Affiliation(s)
- Maxim Itkin
- Interventional Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
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16
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Abstract
Chylothorax is the accumulation of chyle in the pleural space, as a result of damage to the thoracic duct. Chyle is milky fluid enriched with fat secreted from the intestinal cells and lymphatic fluid. Chylothorax in children, is most commonly seen as a complication of cardiothoracic surgery but may occur in newborns or conditions associated with abnormal lymphatics. The diagnosis is based on biochemical analysis of the pleural fluid, which contains chylomicrons, high levels of triglycerides and lymphocytes. Investigations to outline the lymphatic channels can prove helpful in some cases. Initial treatment consists of drainage, dietary modifications, total parenteral nutrition and time for the thoracic duct to heal. Somatostatin and its analogue octreotide may be useful in some cases. Surgery should be considered for patients who fail these initial steps, or in whom complications such as electrolyte and fluid imbalance, malnutrition or immunodeficiency persist. Surgical intervention may be attempted thoracoscopically with repair or ligation of the thoracic duct.
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Affiliation(s)
- Manuel Soto-Martinez
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Parkville, Melbourne, Victoria 3052, Australia.
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17
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Katanyuwong P, Dearani J, Driscoll D. The role of pleurodesis in the management of chylous pleural effusion after surgery for congenital heart disease. Pediatr Cardiol 2009; 30:1112-6. [PMID: 19705186 DOI: 10.1007/s00246-009-9515-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 06/11/2009] [Accepted: 07/31/2009] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Poomiporn Katanyuwong
- Department of Pediatric and Adolescent Medicine, Divisions of Pediatric Cardiology and Cardiovascular Surgery, Mayo Clinic and Foundation and Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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18
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Nath DS, Savla J, Khemani RG, Nussbaum DP, Greene CL, Wells WJ. Thoracic Duct Ligation for Persistent Chylothorax After Pediatric Cardiothoracic Surgery. Ann Thorac Surg 2009; 88:246-51; discussion 251-2. [DOI: 10.1016/j.athoracsur.2009.03.083] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 03/26/2009] [Accepted: 03/27/2009] [Indexed: 01/30/2023]
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19
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Matsukuma E, Aoki Y, Sakai M, Kawamoto N, Watanabe H, Iwagaki S, Takahashi Y, Kawabata I, Kondo N, Uchida Y. Treatment with OK-432 for persistent congenital chylothorax in newborn infants resistant to octreotide. J Pediatr Surg 2009; 44:e37-9. [PMID: 19302843 DOI: 10.1016/j.jpedsurg.2008.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 12/04/2008] [Accepted: 12/05/2008] [Indexed: 11/19/2022]
Abstract
Chylothorax is a relatively uncommon condition defined as an abnormal collection of lymphatic fluid within the pleural space. We are reporting the use of OK-432 for treatment of prolonged idiopathic congenital chylothorax in 2 newborn infants who failed to respond to conservative medical therapy, including octreotide injection.
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Affiliation(s)
- Eiji Matsukuma
- The Department of Pediatrics, Nagara Medical Center, Gifu 502-8558, Japan
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20
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Postoperative chylothorax development is associated with increased incidence and risk profile for central venous thromboses. Pediatr Cardiol 2008; 29:556-61. [PMID: 18030412 DOI: 10.1007/s00246-007-9140-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 09/19/2007] [Accepted: 10/21/2007] [Indexed: 10/22/2022]
Abstract
This study tested the hypothesis that pediatric patients who develop chylothorax (CTX) after surgery for congenital heart disease (CHD) have an elevated incidence and risk profile for central venous thrombosis (CVT). We evaluated 30 patients who developed CTX after surgery for CHD. All but one CTX patient were surgery-, anatomy-, and age-matched with two controls (NON-CTX) to compare their relative risk and incidence of CVT. Using conditional logistic regression analyses, CTX development was associated with significantly longer ventilator dependence (14.8 +/- 10.9 vs. 6.1 +/- 5.9 days, p = 0.003) and a non-significant trend towards more days of central venous catheters (CVC) (19.1 +/- 16.6 vs. 12.2 +/- 10.0 days; p = 0.16) when comparing the period prior to CTX development with the entire hospitalization in NON-CTX patients. CTX development was associated with a significantly elevated mortality risk (Odds Ratio 6.2, 95% CI 1.3-30.9). Minimum and mean daily central venous pressures were significantly higher in the CTX group. Post operative need for extracorporeal membrane oxygenation conferred an increased risk of CTX development in this sample of patients (Odds Ratio 9.9, 95% CI 2.2-44.8). Incidence of documented CVT was 26.7% in the CTX group versus 5.1% in the NON-CTX group. Prospective screening for CVT risk and formation, combined with early removal of CVC may help reduce the incidence of CTX.
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21
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Cozzi DA, Zani A, d'Ambrosio G, Piserà A, Roggini M, Cozzi F. One-stage excision of massive cervicomediastinal lymphangioma in the newborn. Ann Thorac Surg 2007; 84:1027-9. [PMID: 17720430 DOI: 10.1016/j.athoracsur.2007.04.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 04/20/2007] [Accepted: 04/26/2007] [Indexed: 10/22/2022]
Abstract
We report the first neonate successfully treated with one-stage complete excision of massive cervicomediastinal lymphangioma producing alarming respiratory distress. Early postoperative course was complicated by refractory bilateral chylothorax, which effectively responded to insertion of external pleuroperitoneal shunts. At the 6-year follow-up, the child remains symptom free and recurrence free. One-stage resection for cervicomediastinal lymphangioma is curative and well tolerated even shortly after birth.
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Affiliation(s)
- Denis A Cozzi
- Pediatric Surgery Unit, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy.
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22
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Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg 2007; 32:362-9. [PMID: 17580118 DOI: 10.1016/j.ejcts.2007.04.024] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 04/15/2007] [Accepted: 04/18/2007] [Indexed: 12/16/2022] Open
Abstract
Though rare in incidence, chylothorax can lead to significant morbidity and mortality. Its occurrence corresponds to increased mortality following esophagectomy. Leakage of chyle and lymph leads to significant loss of essential proteins, immunoglobulins, fat, vitamins, electrolytes and water. The presence of chylomicrons and a triglyceride level >110 mg/dl in the aspirated pleural fluid confirms the diagnosis of chylothorax. Identifying the aetiology using different diagnostic tests is important in planning treatment. While therapeutic thoracentesis provides relief from respiratory symptoms, the nutritional deficiency will continue to persist or deteriorate unless definitive therapeutic measures are instituted to stop leakage of chyle into the pleural space. Definitive therapy consists of obliteration and prevention of recurrence of chylothorax. Aggressive surgical therapy is recommended for post-traumatic or post-surgical chylothorax.
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Affiliation(s)
- Sukumaran K Nair
- Department of Cardiothoracic Surgery, The Heart Hospital, University College London NHS Trust, 16-18 Westmoreland Street, London W1G 8PH, United Kingdom.
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23
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Chan SY, Lau W, Wong WHS, Cheng LC, Chau AKT, Cheung YF. Chylothorax in Children After Congenital Heart Surgery. Ann Thorac Surg 2006; 82:1650-6. [PMID: 17062221 DOI: 10.1016/j.athoracsur.2006.05.116] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 05/28/2006] [Accepted: 05/31/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND A definitive management strategy for postoperative chylothorax remains elusive. We reviewed our experience in the management of chylothorax in children after congenital heart surgery. METHODS The case records of 51 patients, with a median age of 11 months (range, 4 days to 19.6 years), diagnosed to have postoperative chylothorax between 1981 and 2004 were reviewed. The responses of patients to nutritional modifications, octreotide therapy, and surgical interventions were noted. RESULTS The prevalence of postoperative chylothorax, which developed at a median of 9 days after operation (range, 0 to 24 days), was 0.85% (51 of 5,995). Four patients died, and among the 47 survivors the median duration and total volume of chylous drainage was 15 days (range, 1 to 89 days) and 156 mL/kg (range, 3 to 6,476), respectively. The duration of chyle output was significantly longer after the Fontan-type procedures (p = 0.0006). Twenty-one patients were diagnosed between 1981 and 1999 and managed by nutritional modifications, 2 of whom required further surgical interventions. Of the 30 patients diagnosed between 2000 and 2004, 12 responded to nutritional modifications alone while 18 were started on octreotide therapy at a median of 19.5 days (range, 7 to 35 days) after the onset of chylothorax. Fifteen of the 18 (83%) patients responded to octreotide therapy at 15.3 +/- 5.5 days after starting octreotide, while 3 required further surgical interventions. None developed side effects from octreotide therapy. CONCLUSIONS Octreotide has been incorporated into the management algorithm of postoperative chylothorax and appears to be a useful adjunctive therapy.
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Affiliation(s)
- Shu-yan Chan
- Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
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24
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Abstract
We report the use of the octreotide (a somatostatin analogue) in the treatment of idiopathic congenital chylothorax in a patient with Turner's syndrome who had previously failed conservative medical therapy. The patient improved rapidly after initiation of octreotide with complete resolution after 5 days of continuous therapy (10 microg/kg per hour).
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Affiliation(s)
- Alix Paget-Brown
- Division of Neonatology, Department of Pediatrics, Children's Medical Center, University of Virginia, School of Medicine, P.O. Box 800386, Charlottesville, VA 22901, USA
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25
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Lim KA, Kim SH, Huh J, Kang IS, Lee HJ, Jun TG, Park PW. Somatostatin for postoperative chylothorax after surgery for children with congenital heart disease. J Korean Med Sci 2005; 20:947-51. [PMID: 16361802 PMCID: PMC2779324 DOI: 10.3346/jkms.2005.20.6.947] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chylothorax is a rare but serious postoperative condition with a high rate of morbidity that may lead to death of children with congenital heart disease. Here we reviewed nine consecutive cases with chylothorax in infants and children following cardiac surgery from March 2002 to February 2003. Somatostatin was added to conservative treatment protocol to increase effectiveness of therapy in all cases. The duration of somatostatin therapy varied from 7 to 32 days. All cases of chylothorax were successfully treated with intravenous infusion of somatostatin as an adjunctive treatment. Even though two cases showed rebound phenomena, we avoided any surgical procedure in the nine patients who treated with conservative management combined with somatostatin. No significant side effects of somatostatin were observed. It seems that somatostatin is effective, noninvasive and safe therapeutic modality. It can be used as an adjunctive treatment to conservative management to control postoperative chylothorax in children with congenital heart disease.
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Affiliation(s)
- Kyoung Ah Lim
- Department of Pediatrics, Pochon CHA University College of Medicine, Pochon, Korea
| | - Sung Hye Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heung Jae Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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26
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Abstract
Congenital chylothorax is the accumulation of lymphatic fluid within the pleural space. Cases unresponsive to conservative management usually require surgery. Octreotide has been used successfully to treat post-traumatic chylothoraces in the pediatric and adult population. Its exact mode of action is uncertain but it is believed to reduce lymphatic drainage by a direct action on splanchnic lymph flow. We report a case of congenital chylothorax where surgery was avoided with the compassionate trial of the somatostatin analogue, octreotide. A 33 week gestation female infant, born with the presence of large bilateral pleural effusion, was unresponsive to conservative management. Octreotide was commenced on day 15, with 10 days of an octreotide infusion, initially 0.5 microg/kg per hour and increased daily by 1 microg/kg per hour to 10 microg/kg per hour. Treatment was associated with prompt respiratory improvement prior to cessation of pleural drainage over the 10 day. She remains well at 6 months of age. Further studies are required to ascertain its true value in congenital chylothorax.
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Affiliation(s)
- Yasin Sahin
- Department of Pediatrics, SSK Region Hospital and Medical Faculty of Gaziantep University, Turkey.
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27
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Gómez-Caro Andrés A, Marrón Fernández C, Moradiellos Díez FJ, Díaz-Hellín Gude V, Pérez Antón JA, Martín de Nicolás JL. [Octreotide for conservative management of postoperative chylothorax]. Arch Bronconeumol 2005; 40:473-5. [PMID: 15491540 DOI: 10.1016/s1579-2129(06)60357-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postoperative chylothorax after lung resection is a major problem leading to morbidity and mortality and requiring reoperation in a large number of cases. The most advisable and least aggressive option is conservative management in progressive stages: a diet rich in medium-chain fatty acids and/or total parenteral nutrition, in addition to chest tube drainage. Including octreotide in this regimen seems to be related to a higher success rate without the need for surgery. We report a case in which the effectiveness and safety of octreotide in the resolution of postoperative chylothorax was excellent.
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28
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Abstract
Congenital chylothorax is the accumulation of lymphatic fluid within the pleural space. Cases unresponsive to conservative management usually require surgery. Octreotide has been used successfully to treat post-traumatic chylothoraces in the paediatric and adult population. Its exact mode of action is uncertain but it is believed to reduce lymphatic drainage by a direct action on splanchnic lymph flow. We report a case of congenital chylothorax where surgery was avoided with the compassionate trial of the somatostatin analogue, octreotide. Treatment was associated with prompt respiratory improvement prior to cessation of pleural drainage. Further studies are required to ascertain its true value in congenital chylothorax.
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Affiliation(s)
- S V Rasiah
- Department of Newborn Care, Royal Hospital for Women, Sydney, NSW 2031, Australia
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29
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Gómez-Caro Andrés A, Marrón Fernández C, Moradiellos Díez F, Díaz-Hellín Gude V, Pérez Antón J, Martín de Nicolás J. Tratamiento conservador con octreótido del quilotórax posquirúrgico. Arch Bronconeumol 2004. [DOI: 10.1016/s0300-2896(04)75574-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Tomić I, Plavec G, Karlicić V, Spasić V, Rusović S, Stanić V, Cvijanović V, Ristanović A. [Chylous effusions]. VOJNOSANIT PREGL 2003; 60:613-20. [PMID: 14608841 DOI: 10.2298/vsp0305613t] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This paper presents 4 patients with chylothorax, and one patient with bilateral chylothorax and chyloperitoneum. The chylous effusions were of benign etiology, developed as a complication of miliary tuberculosis (1 patient), after L-2 vertebral body fracture (1 patient), and idiopathic (2 patients). The diagnosis was confirmed by the presence of chylomicrons and high content of triglycerides in the effusion, ranged 11.9-29.1 mmol/l. Lymphangiography showed multiple abnormalities of lymphatic system, the obstruction of ductus thoracicus, dilatation and convulsion of lymphatic channels, but the site of lymphatic leak was not detected. The treatment included an extended period of pleural and peritoneal drainage with total parenteral nutrition (1 patient), pleurodesis using Corynebacterium parvum (2 patients), and surgical partial parietal pleurectomy with continuous drainage (1 patient). The treatment was successful in all patients.
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Affiliation(s)
- Ilija Tomić
- Vojnomedicinska akademija, Klinika za plućne bolesti, Beograd
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31
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Mavroudis C, Sade RM. The Southern Thoracic Surgical Association 50th anniversary celebration: the impact of STSA pediatric cardiothoracic surgery manuscripts on surgical practice. Ann Thorac Surg 2003; 76:S47-67. [PMID: 14596980 DOI: 10.1016/s0003-4975(03)01508-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Members of the Southern Thoracic Surgical Association (STSA) have presented important pediatric cardiothoracic surgery papers at the annual meetings over the last 50 years. In order to determine the influence of these presentations on the practice of surgery, a review was undertaken. Early papers were characterized by emerging advances in open-heart surgery, anatomic congenital heart studies, and electrophysiologic discoveries that extended life with pacemakers. Later years were characterized by innovative myocardial preservation methods, improved cardiopulmonary bypass techniques, expanded homograft availability, emphasis on accurate repairs, intraoperative transesophageal echocardiography, and cardiopulmonary transplantation. METHODS All but one of the scientific programs of the annual meetings (that of 1964) were located. The programs were reviewed and 180 presentations were identified on topics in congenital heart disease, pediatric thoracic disease, and pediatric thoracic wall abnormalities. Of those 180 oral presentations, 155 manuscripts (86%) were eventually published or in press and available for critical review and analysis. Manuscripts were grouped by diagnosis or therapeutic intervention. We determined a "cumulative citation frequency" (CCF), which measures the number of times an article is cited in the bibliography of related papers in the universe of participating journals. The selected manuscripts were compared with the historic landmark contributions and the existing trends at the time, and the number of articles both by individual authors and from institutions were tallied. RESULTS Grouping by authors and institutions showed that 100 of 155 pediatric cardiothoracic manuscripts (65%) originated from 13 institutions. The CCF for the 20 leading articles ranged from 26 to 93. CONCLUSIONS This historical STSA 50-year record of pediatric cardiothoracic advances was accomplished in a milieu of collegial respect and camaraderie. Our annual meetings over the years have provided a venue for thoracic surgeons to share their ideas, innovations, and scientific inquiry. These contributions have significantly affected the practice of pediatric cardiothoracic surgery. The STSA has worked for 50 years and we trust that it will work for another 50 years and beyond.
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Affiliation(s)
- Constantine Mavroudis
- Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
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Abstract
Chylothorax is an unusual complication of surgical procedures within the chest. Early recognition is important so that appropriate conservative measures can be applied. Operative intervention after a short course of supportive therapy will control most chyle fistulas. Methods of diagnosis in the postoperative setting and literature supporting various treatment options are the focus of this article.
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Affiliation(s)
- David W Johnstone
- Department of Cardiothoracic Surgery, University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box Surgery, Rochester, NY 14642, USA.
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Santolaya-Forgas J. How do we counsel patients carrying a fetus with pleural effusions? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 18:305-308. [PMID: 11778987 DOI: 10.1046/j.0960-7692.2001.00553.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- J Santolaya-Forgas
- Department of Obstetrics and Gynecology, Texas Tech University, Amarillo 79106, USA.
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