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Review
. 2021 Mar 10;13(3):e13811.
doi: 10.7759/cureus.13811.

Post-Operative Chylothorax in Children Undergoing Congenital Heart Surgery

Mehnaz Atiq Ahmed Sr  1
Affiliations
Review

Post-Operative Chylothorax in Children Undergoing Congenital Heart Surgery

Mehnaz Atiq Ahmed Sr. Cureus. .

Abstract

Chylothorax is a rare postoperative complication of congenital heart surgery. It has high morbidity with increased hospital stay and cost of treatment. Damage to the thoracic duct, disruption of accessory lymphatic vessels, and increased venous pressure exceeding that in the thoracic duct have been proposed as the possible causes of chylothorax after surgery for congenital heart disease. Prompt diagnose with early initiation of treatment will reduce the duration of drainage. Staged treatment is the general principle in managing this serious complication. Loss of chyle leads to volume, nutritional and electrolyte depletion, immunological deficiencies and hematological complications. Identifying the underlying cause and addressing it is crucial to definitive management.

Keywords: chylothorax; congenital heart surgery; post-operative complications.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Anatomy of lymphatic vascular system.
(A) Lymphatic vascular system consists of: 1. tissue lymphatic capillaries; 2. collecting vessels; 3. lymph nodes; 4. right thoracic duct. (B) Lymphatic capillaries absorb fluid through breaches endothelium and button-like junctions to form lymph. (C) collecting vessel with zipper-like junctions, valves and smooth muscle cells (SMC). (D) Lymph node with multiple afferent and one efferent vessel. (E) Lymph vessel provided with valves drain into internal jugular vein (IJV), external jugular vein (EJV) and subclavian vein (SCV). Adapted from Aspelund et al., Circulation Research. 2016; 118(3): 515–530 [5]. With permission.
Figure 2
Figure 2. Management guidelines for post-operative chylothorax.
Abbreviations: PICC: peripherally inserted central catheter; NPO: nil per oral; TPN: total parenteral nutrition.
See this image and copyright information in PMC

References

    1. Presentations and management of different causes of chylothorax in children: one medical center’s experience. Lin CH, Lin WC, Changd JS. BioMedicine. 2017;7:30–34. - PMC - PubMed
    1. Chylothorax after surgery on congenital heart disease in newborns and infants - risk factors and efficacy of MCT-diet. Biewer ES, Zürn C, Arnold R, Glöckler M, Schulte-Mönting J, Schlensak C, Dittrich S. J Cardiothorac Surg. 2010;5:127. - PMC - PubMed
    1. Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database. Mery CM, Moffett BS, Khan MS, et al. J Thorac Cardiovasc Surg. 2014;147:678–686. - PubMed
    1. Chylothorax in children after congenital heart surgery. Chan SY, Lau W, Wong WHS, Cheng LC, Chau AKT, Cheung YF. Ann Thorac Surg. 2006;85:1650–1656. - PubMed
    1. Lymphatic system in cardiovascular medicine. Aspelund A, Robciuc MR, Karaman S, Makinen T, Alitalo K. Circ Res. 2016;118:515–530. - PubMed