Saito Kanchi, Saiki Hirofumi, Tsuchiya Shigekuni, Takizawa Yurie, Sato Akira, Goto Takuya, Toya Yukiko, Matsumoto Atsushi, Koizumi Junichi, Oyama Kotaro, Akasaka Manami
Pediatric Cardiology, School of Medicine, Iwate Medical University, Shiwa, JPN.
Neonatology, School of Medicine, Iwate Medical University, Shiwa, JPN.
Cureus. 2022 Mar 26;14(3):e23506. doi: 10.7759/cureus.23506. eCollection 2022 Mar.
Chylothorax is a critical complication after surgery for congenital heart disease, which markedly compromises the postoperative course with increased mortality. As the cardiovascular load additively causes stagnation of the thoracic duct, chylothorax after palliative cardiac surgery can be highly refractory to the therapies. Here we report a case of two patients with refractory chylothorax attributed to hemodynamic load which was successfully treated with minocycline pleurodesis. In combination with congenital heart disease, extremely low birth weight coupled with prematurity in case 1 and venous obstruction with excessive volume load due to additional aortopulmonary shunt in case 2 additively increased resistance to the therapies, including fasting with total parenteral nutrition (TPN), XIII factor supplementation, octreotide infusion, as well as the use of steroids. As pleural effusion was sustained at more than 50 ml/kg/day, the condition of both patients deteriorated severely; pleurodesis using minocycline was urgently introduced. Pleural effusion declined at every session and both cases were in remission in a few sessions without unfavorable acute reaction. No symptoms suspecting chronic adverse effects were observed during follow-up, including respiratory dysfunction, pulmonary hypertension, tooth staining, or abnormal bone mineralization. Although the application of minocycline for children should be minimized, minocycline pleurodesis can be an option for patients with refractory and life-threatening chylothorax.
乳糜胸是先天性心脏病手术后的一种严重并发症，显著影响术后病程并增加死亡率。由于心血管负荷会额外导致胸导管淤滞，姑息性心脏手术后的乳糜胸对治疗可能具有高度难治性。在此，我们报告两例因血流动力学负荷导致难治性乳糜胸的患者，经米诺环素胸膜固定术成功治疗。在病例1中，先天性心脏病合并极低出生体重和早产，病例2中除先天性心脏病外，由于额外的主肺动脉分流导致静脉阻塞和容量负荷过重，这些因素共同增加了对包括禁食联合全胃肠外营养（TPN）、补充 XIII 因子、输注奥曲肽以及使用类固醇等治疗的抵抗性。由于胸腔积液持续超过50 ml/（kg·天），两名患者的病情均严重恶化；于是紧急采用米诺环素进行胸膜固定术。每次术后胸腔积液均减少，两例患者经几次术后均缓解，且无不良急性反应。随访期间未观察到怀疑慢性不良反应的症状，包括呼吸功能障碍、肺动脉高压、牙齿染色或骨矿化异常。尽管儿童使用米诺环素应尽量减少，但米诺环素胸膜固定术可为难治性且危及生命的乳糜胸患者提供一种选择。
