Chylothorax After Cardiac Surgery

Abstract

In the following article we present a case of postoperative chylothorax as rare and severe complication after cardiac surgery. We present a case of 56-year-old man after double-valve replacement procedure and aorto-coronary artery bypass grafting, including pedicled left internal mammary artery towards left anterior descending artery. By the tenth postoperative day the total amount of drained milky white fluid from the left pleural cavity reached the colossal volume of 13 040 ml, despite the conservative therapy with intravenous Sandostatin (Octreotide) and parenteral feeding with a solution rich in medium chain triglycerides and amino acids – OliClínomel. The results of the biochemical analysis confirmed the diagnosis chylothorax. On the tenth postoperative day, a revision of the left pleural cavity through left thoracotomy was performed and lesion of the thoracic duct was identified. The lesion was sutured and secured with fibrin tissue glue – Tissucol for definitive treatment of the lymphorrhagia. The combined therapeutic and surgical approach concerning this serious complication turned out to be effective, and the patient was discharged on the thirty-second postoperative day with significant clinical improvement without ultra-sound and x-ray data for left pleural effusion.

Keywords

• chylothorax
• double-valve replacement
• left internal mammary artery
• complications