Abstract Ref Number = APCP1218
Chylothorax After Cardiothoracic Surgery in Children
Retno Widyaningsih, Dimas Dwi Saputro, Rifan Fauzie, Winda Azwani, Tinuk Agung Meilany, Fikri
Respirology, Cardiology and Nutrition Working Group Harapan Kita Women and Children Hospital
Cardiology Department National Cardiac Center Harapan Kita
Background: Chylothorax, the accumulation of chyle in the pleural space, is a relatively rare cause of pleural effusion in children. It can occur as a significant problem in pediatric cardiac surgery and is associated with increased mortality, cost, and length of stay.
Case: A 2 years 7 months old male, weight 9,5 kg referred to Harapan Kita Women and Children Hospital with the chief complaint frequent sianosis since 2 weeks before hospital admission accompanied by cough with phlegm and common cold accompanied by shortness of breath. No fever. There no complaints of urinates and defecate. The patient had previous history of Tetralogy of Fallot repair surgery which later developed a complication of chylothorax 3 months earlier.
At day 1 monitoring, chest X-ray showed a minimal left pleural effusion, then patient was given ceftriaxone as a antibiotic therapy. On the 3rd day monitoring the patient got heavier shortness of breath and the chest X-ray showed the massive left pleural effusion and chest tube procedure was done. Milky liquid obtained and laboratory test consistent with the chylous. Patient assessed as a recurrent chylothorax. Medium-chain triglycerides was administerred in this patient for 5 days. Evaluation of the chylous fluid volume on the chest tube drain was done but effusion was not reduced. Subsequent monitoring was continued by administering total parenteral nutrition with ocreotide 120mcg/kg/day with target amount of drainage less than 5 ml/kg/day. After 2 weeks the volume of chylous fluid improved, but then re-increased, so decided to perform pleurodesis procedure.
Learning Points: Chylothorax increases duration of hospitalization after cardiovascular surgery in children. It can cause significant respiratory morbidity, as well as lead to malnutrition and immunodeﬁciency. Thus, a chylothorax requires timely diagnosis and treatment. Nutritional strategies remain the cornerstone for management of chylothorax.
Keywords: chylothorax chest tube drainage medium-chain triglycerides