Chylous accumulation in the mediastinal space following coronary artery bypass graft surgery
Abstract
Chylomediastinum as a complication of cardiovascular surgery has a reported incidence of lower than 0,5% and is extremely rare following intrapericardial pro-cedures. The origin of this complication is a direct injury to the anterior medi-astinum lymphatics in the thymus area or the thoracic duct, at the junction of the left jugular and subclavian veins, obstructing thoracic duct drainage. Firstly, con-servative treatment with low fat and medium chain triglyceride diet is prefered by cutting oral feding. If the drainage persists despite 2 weeks of conservative treatment, the surgical ligation of the ductus thoracicus may be considered for the management of this complication. We present the mediastinal chylous fluid accu-mulation in a male patient who underwent revision due to bleeding on postoper-ative second day after coronary artery bypass surgery.
Downloads
References
1. Shanmugam G, Sundar P, Shukla V, Korula RJ.Chylopericardial tamponade following atrial septal defect repair: an usual entity. Indian J ThoracCardiovasc Surg. 2003;19(2):124-5.
2. Thomas CS, McGoon DC. Isolated massive chylopericardium following cardiopulmonary bypass. J ThoracCardiovasc Surg. 1971;61(6):945-8.
3. Sharpe DA, Pullen MD, McGoldrick JP.A minimally invasive approach to chylopericardium after coronary artery surgery. Ann Thorac Surg. 1999;68(3):1062-3.
4. Pitol R, Pederiva JR, Pasin F, Vitola D.Isolated chylopericardium after cardiac surgery.Arq Bras Cardiol. 2004;82(4):384-9.
5. Dib C, Tajik AJ, Park S, Kheir ME,Khandieria B,Mookadam F.Chylopericardium in adults: A literature review over the past decade (1996-2006). J ThoracCardiovasc Surg. 2008;136(3):650-6.
6. Mundra V,Savage EB,Novaro GM,Asher CR. Delayedchylouspericardialeffusionafteraorticvalvereplacement. Tex Heart Inst J.2011;38(4):431-2.
7. Volker JH. Thoracic duct - Formation, course, connection, tributaries and development[Internet].Earth’sLab; 2018 [citado 3 Mar 2019]. Disponible en: https://www.earthslab.com/anatomy/thoracic-duct-formation-course-connection-tributaries-and-development/
8. Tchervenkov CI, Dobell AR. Chylopericardium following cardiac surgery. Can J Surg. 1985;28(6):542-3.
9. Pollard WM,Schuchmann GF,Bowen TE. Isolated chylopericardium after cardiac operations. J ThoracCardiovasc Surg. 1981;81(6):943-6.
10. Lee Y, Lee WK, Doromal N, Ganepola GA, Hutchinson J. Cardiac tamponade resulting from massive chylopericardium after an aorta-coronary bypass operation. J ThoracCardiovasc Surg. 1987;94(3):449-50.
11. Ates A, Erkut B, Yekeler I. Chyloperıcardıum after mitral valve replacement. AÜTD [Internet]. 2002 [citado 5 Mar 2019];34:17-9. Disponible en: https://www.eajm.org/content/files/sayilar/137/buyuk/pdf_EAJM_73.pdf
12. Sachithanandan A, Nanjaiah P, Rooney SJ, Rajesh PB.Idiopathic primary chylopericardium with associated chylothorax following coronary artery surgery - Successful conservative treatment. J Card Surg. 2008;23(3):258-9.
13. Kelly RF, Shumway SJ. Conservative management of postoperative chylothorax using somatostatin. Ann Thorac Surg. 2000;69(6):1944-5.
14. Rimensberger PC, Müller-Schenker B, Kalangos A, Beghetti M. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg. 1998;66(1):253-4.
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
