Sleem Bshara, Abdul Khalek Jad, Makarem Adham, Yamout Salah, El Rassi Christophe, Zareef Rana, Obeid Mounir, El Rassi Issam, Bitar Fadi, Arabi Mariam
Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Cardiol Young. 2025 Apr;35(4):798-804. doi: 10.1017/S104795112500126X. Epub 2025 Mar 13.
Chylothorax, a postoperative complication of CHD surgery, involves chyle accumulation in the pleural cavity, posing challenges in diagnosis and management. This retrospective study investigates the prevalence, aetiology, management, and outcomes of postoperative chylothorax in paediatric patients undergoing cardiac corrective surgery at a tertiary care centre over 15 years. Medical records of paediatric patients who underwent cardiothoracic surgery at the Children's Heart Center at the American University of Beirut Medical Center between 2007 and 2022 were retrospectively reviewed. Data collection included demographic characteristics, blood parameters, chylous fluid characteristics, diagnostic criteria, treatment modalities, and hospitalisation details. Ethical approval was obtained, and descriptive statistics were employed using SAS 9.4. Among 2,997 children who underwent cardiothoracic surgery, nineteen cases of postoperative chylothorax were identified. The majority were females (63.2%) with a median age of 9 months. Glenn, Fontan, and Blalock-Taussig shunt-related surgeries were the most common operations associated with chylothorax. Single ventricle physiology was the predominant CHD observed (58%). Diagnosis relied primarily on clinical presentation, imaging studies, and triglyceride levels in pleural fluid. Treatment options included conservative dietary modifications, medical therapy such as octreotide, and surgical intervention if necessary. No mortalities were reported, and patients were adequately followed up. This study sheds light on postoperative chylothorax in paediatric cardiac patients, offering insights into its epidemiology, aetiology, clinical features, and treatment outcomes. While conservative and medical approaches effectively managed chylothorax in this group, larger studies are needed to develop standardised diagnostic and treatment protocols, improving outcomes in paediatric patients with postoperative chylothorax.
乳糜胸是先天性心脏病（CHD）手术的术后并发症，表现为乳糜液在胸腔内积聚，给诊断和治疗带来挑战。这项回顾性研究调查了一家三级医疗中心15年间接受心脏矫正手术的儿科患者术后乳糜胸的患病率、病因、治疗及预后情况。对2007年至2022年期间在美国贝鲁特美国大学医学中心儿童心脏中心接受心胸外科手术的儿科患者的病历进行了回顾性分析。数据收集包括人口统计学特征、血液参数、乳糜液特征、诊断标准、治疗方式及住院详情。研究获得了伦理批准，并使用SAS 9.4进行描述性统计分析。在2997例接受心胸外科手术的儿童中，确诊19例术后乳糜胸。大多数为女性（63.2%），中位年龄为9个月。与乳糜胸相关的最常见手术是格林分流术、Fontan手术和Blalock-Taussig分流术。观察到的主要先天性心脏病类型是单心室生理结构（58%）。诊断主要依靠临床表现、影像学检查及胸腔积液中的甘油三酯水平。治疗选择包括保守的饮食调整、使用奥曲肽等药物治疗以及必要时的手术干预。未报告死亡病例，且对患者进行了充分的随访。本研究揭示了儿科心脏手术患者术后乳糜胸的情况，为其流行病学、病因、临床特征及治疗结果提供了见解。虽然保守治疗和药物治疗有效地控制了该组患者的乳糜胸，但仍需要更大规模的研究来制定标准化的诊断和治疗方案，以改善儿科术后乳糜胸患者的预后。
