Law Mark A, McMahon William S, Hock Kristal M, Zaccagni Hayden J, Borasino Santiago, Alten Jeffrey A
Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Ala, USA.
Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA.
Congenit Heart Dis. 2015 Jul-Aug;10(4):E155-63. doi: 10.1111/chd.12246. Epub 2015 Jan 20.
Chylothorax complicates the postoperative course of patients after congenital heart surgery. Innominate vein thrombosis and stenosis have been associated with postoperative chylothorax. Revascularization and angioplasty can be accomplished using transcatheter techniques. We report our experience with this procedure for the management of postoperative chylothorax.
This is a retrospective case series of patients who underwent catheter revascularization and/or angioplasty of the innominate vein following cardiac surgery at our institution from January 1, 2008 through April 9, 2014.
The cardiovascular intensive care unit and cardiac catheterization laboratory at the University of Alabama at Birmingham and Benjamin Russell Hospital for Children in Birmingham, Alabama were used as settings for the study.
Out of 112 patients with postoperative chylothorax, 7 (6.3%) underwent transcatheter dilation of the innominate vein for occlusion/stenosis. The median age of the cohort was 1 month (15 days-6 years); median weight was 3 kg (2.7-22.2). Diagnosis was made a median 8 days (2-20) and persisted for a median of 24 days (9-44). Most patients failed medical management (low fat diet, nothing by mouth, and/or octreotide).
Cardiac catheterization occurred at a median 9 days (2-29) after chylothorax diagnosis. Median chest tube output on the day prior to procedure was 63 (12-149) cc/kg/day and decreased to 23 (0-64) cc/kg/day 2 days postprocedure (P = .01). Effusions resolved in a median of 5 days (1-16). There were no clinical complications postcatheterization. All patients who have undergone repeat angiography have maintained patency of the innominate vein. There was no mortality. Complications from chylothorax included prolong hospitalization, hyponatremia, hypoproteinemia, coagulopathy, lymphopenia, and infection.
Innominate vein occlusion and stenosis associated with chylous effusion are amenable to transcatheter revascularization and/or angioplasty, consistently leading to improvement, if not full resolution of chylothorax.
乳糜胸是先天性心脏手术后患者术后病程中的并发症。无名静脉血栓形成和狭窄与术后乳糜胸有关。可采用经导管技术进行血管重建和血管成形术。我们报告了我们使用该手术治疗术后乳糜胸的经验。
这是一项回顾性病例系列研究，研究对象为2008年1月1日至2014年4月9日在我院接受心脏手术后无名静脉导管血管重建和/或血管成形术的患者。
阿拉巴马大学伯明翰分校和阿拉巴马州伯明翰市本杰明·拉塞尔儿童医院的心血管重症监护病房和心脏导管实验室作为研究场所。
在112例术后乳糜胸患者中，7例（6.3%）因无名静脉闭塞/狭窄接受了经导管扩张术。该队列的中位年龄为1个月（15天至6岁）；中位体重为3 kg（2.7至22.2 kg）。诊断的中位时间为8天（2至20天），持续时间的中位值为24天（9至44天）。大多数患者药物治疗失败（低脂饮食、禁食和/或使用奥曲肽）。
心脏导管检查在乳糜胸诊断后的中位时间为9天（2至29天）进行。手术前一天胸管引流量的中位值为63（12至149）cc/（kg·天），术后2天降至23（0至64）cc/（kg·天）（P = 0.01）。胸腔积液在中位时间5天（1至16天）内消退。导管插入术后无临床并发症。所有接受重复血管造影的患者无名静脉均保持通畅。无死亡病例。乳糜胸的并发症包括住院时间延长、低钠血症、低蛋白血症、凝血功能障碍、淋巴细胞减少和感染。
与乳糜性胸腔积液相关的无名静脉闭塞和狭窄适合经导管血管重建和/或血管成形术，即使不能完全消除乳糜胸，也能持续改善病情。
