Abstract
IntroductionChylothorax is a lymphatic extravasation into pleural cavity and its incidence is 0.25%-5.3% in children undergoing cardiac surgery.ObjectiveTo evaluate the incidence of chylothorax in pediatrics patients operated, linking it in each surgical intervention. Evaluate treatment types and efficiency.MethodsRetrospective study using medical records of children undergoing cardiac surgery in the Hospital do Coração between 2004 and 2014. For statistical analysis, qualitative variables by absolute frequency and relative frequency; quantitative variables, by median of 25 and 75 percentiles, as they did not present normal distribution (Shapiro-Wilk, P<0.05). The Chi-square test was used for the association between type of treatment and result. The adopted confidence level was 95%.ResultsIncidence of chylothorax was 2.1% (0.9% in intracardiac surgery, 1.7% correction of patent ductus arteriosus and aortic coarctation, 8.3% Glenn's surgery, 11.8% total cavopulmonary surgery and 3% in others). Among treatments, fasting associated with total parenteral nutrition (TPN) resolved 51% of the cases. Hypoglossal diet had failed treatment and surgical referral in 22% of the cases. Fasting with TPN associated with octreotide had success in the treatment of chylothorax in a period exceeding 15 days in 78% of cases, and 3.7% were referred for surgery.ConclusionAccording to the results, incidence of chylothorax was 2.18%. Treatment with fasting and TPN leads to resolutions in 86.5%, and the association with octreotide was successful in 85.1% of cases, showing an efficient option, while the treatment with hypoglossal diet had therapeutic failure in 22% of the cases in which it was used.
Highlights
Chylothorax is a lymphatic extravasation into pleural cavity and its incidence is 0.25%-5.3% in children undergoing cardiac surgery
Fasting with total parenteral nutrition (TPN) associated with octreotide had success in the treatment of chylothorax in a period exceeding 15 days in 78% of cases, and 3.7% were referred for surgery
Treatment with fasting and TPN leads to resolutions in 86.5%, and the association with octreotide was successful in 85.1% of cases, showing an efficient option, while the treatment with hypoglossal diet had therapeutic failure in 22% of the cases in which it was used
Summary
Chylothorax is a lymphatic extravasation into pleural cavity and its incidence is 0.25%-5.3% in children undergoing cardiac surgery. Chylothorax is a lymphatic fluid extravasation into pleural cavity. In undergoing cardiac surgery children, chylothorax incidence is between 0.25% and 5.3%[1,2,3,4,5,6] and may occur through direct injury, mainly in the correction of the ductus arteriosus and coarctation of the aorta, due to the anatomical proximity to the thoracic duct originating from the chyle cistern, between L3 and T10, ascends to the thoracic region at the time of aortic hiatus between T10 and T12, and ends its course in an anastomosis at the junction of the subclavian vein and left internal jugular vein[7]. With the evolution of pediatric cardiac surgery and concomitant increase in complexity, an increase in the incidence of chylothorax as a postoperative complication of these procedures could be noted, and pediatric cardiac surgery is the main cause of chylothorax in terciary hospitals[2,4].
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