Chylothorax in paedriatric cardiovascular surgery

Abstract

Chylothorax is an unusual complication of cardiothoracic surgery. Previous studies in children have shown a variable incidence and mortality rate. In a retrospective study of 314 patients who underwent cardiac surgery we identified 15 cases of chylothorax. This complication was not only associated with intrapericardial surgery but also with extrapericardial procedures and was diagnosed during the first week after commencing enteral feeding. In 11/15 patients treatment with a lipid free diet was sufficient to resolve this complication; in 3/15 total parental nutrition was required. Medical therapy with a lipid free diet is often effective during the first two weeks. Only 1 patient underwent surgical treatment, this case being associated with a SVC thrombosis. The children with a chylothorax required a longer period of mechanical ventilation and remained in the ICU for a longer period, there were no deaths. Chylothorax is an infrequent complication of cardiac surgery and has a good prognosis, the majority resolving with medical treatment. This complication increases the costs of cardiothoracic surgery because of the prolonged hospitalisation.