Mundra Vishal, Savage Edward B, Novaro Gian M, Asher Craig R
Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL 33331, USA.
Tex Heart Inst J. 2011;38(4):431-2.
Chylopericardium after cardiac surgery is rare, and there are few reports of its occurrence after aortic valve surgery. Chylous pericardial effusion 4 months after aortic valve replacement for endocarditis is highly unusual.Herein, we report the case of a 54-year-old man who had undergone bioprosthetic aortic valve replacement because of endocarditis and valvular dysfunction. Two months later, he underwent pericardiocentesis twice because of large pericardial effusions consisting of pinkish white fluid with predominant lymphocytes. Four months after valve replacement, he presented with recurrent effusion consistent with early tamponade, and a pericardial window was created. At surgery, 1,500 cc of milky white fluid was recovered, and the diagnosis of chylopericardium was made. Postoperative high-volume drainage prompted thoracic duct ligation, which was curative.
心脏手术后并发乳糜性心包炎较为罕见，主动脉瓣手术后发生该病症的报道更是寥寥无几。因感染性心内膜炎行主动脉瓣置换术后4个月出现乳糜性心包积液的情况极为罕见。在此，我们报告一例54岁男性患者，该患者因感染性心内膜炎及瓣膜功能障碍接受了生物人工主动脉瓣置换术。两个月后，因大量心包积液（积液为粉白色，以淋巴细胞为主），他接受了两次心包穿刺术。瓣膜置换术后4个月，他再次出现积液，伴有早期心包填塞症状，遂行心包开窗术。手术中，引流出1500毫升乳白色液体，确诊为乳糜性心包炎。术后大量引流促使进行胸导管结扎，最终治愈。
