CHYLOTHORAX AFTER SURGERY FOR CONGENITAL HEART-DISEASE IN CHILDREN

We reviewed retrospectively the clinical and surgical data from 9 chil dren with postoperative chylothorax secondary to cardiac surgery for c ongenital heart disease seen over a 3 year period. Mean age was 26 mon ths and 6 patients were female. The procedures performed were 2 Blaloc k-Taussig shunts, 6 Bidirectional Glenn anastomoses and 1 modified Fon tan procedure. Diagnosis of chylothorax was made by classical means. T he overall incidence of chylothorax was 0.8%, with the relative incide nces being 2.5% for Blalock-Taussig, 2.7% for Fontan, and 11.7% for th e Glenn procedures. All patients were initially treated conservatively with chest tube drainage and hypercaloric diet suplemented with mediu m chain triglycerides. Parenteral nutrition was needed in 2 patients, one because of sepsis and the other because of progressive malnourishm ent. High output fistulas and long periods of drainage were noted afte r cavo-pulmonary procedures. Up to 12% weight loss was observed in 6 p atients, one patient was successfully treated of pneumonia and another died of Pseudomonas aeruginosa sepsis. Two patients required chemical pleurodesis because of unabated drainage, with the others being succe ssfully treated conservatively. Chylothorax is a common complication a fter bidirectional Glenn procedures, and is associated with considerab le morbidity and mortality. Earlier operative intervention may be requ ired in these patients. Pleurodesis is a simple, safe, and effective p rocedure to stop chylous flow.