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Ann Thorac Surg 1998;66:253-254
© 1998 The Society of Thoracic Surgeons

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Case Reports

Treatment of a persistent postoperative chylothorax with somatostatin

^a Department of Pediatrics, Hôpital des Enfants, University Hospital of Geneva, Geneva, Switzerland
^b Department of Cardiovascular Surgery, Hôpital des Enfants, University Hospital of Geneva, Geneva, Switzerland

Accepted for publication January 31, 1998.

Address reprint requests to Dr Rimensberger, Critical Care, Department of Pediatrics, Hôpital des Enfants, University Hospital of Geneva, 6, Rue Willy-Donzé, CH-1211 Geneva 14, Switzerland
e-mail: (rimensberger-peter{at}hcuge.ch)

	Abstract

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Chylothorax is a rare but potentially serious complication of pediatric cardiac operations. We report the case of a 4-month-old boy who underwent a Senning procedure for correction of D-transposition of the great vessels. A persistent postoperative chylothorax developed, necessitating continuous drainage, despite conservative treatment over 3 weeks. Thereafter, continuous somatostatin infusion for 14 days led to the reduction and finally cessation of chyle production. This treatment allowed early enteral feeding and avoided further surgical intervention.

	Introduction

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Chylothorax is a rare but potentially serious complication of pediatric cardiac operations, with an incidence of around 1% [1]. Conservative therapy with the use of a low-fat diet containing medium-chain triglycerides or total parenteral nutrition, combined with pleural drainage, is often effective. Operation is advocated after 3 to 4 weeks of unsuccessful nonoperative treatment [2]. Different surgical methods have been described (eg, ligation of the thoracic duct, pleuroperitoneal shunt, pleurodesis), but the results are not always very satisfactory [2–4].

A 4-month-old boy (weight, 5 kg) underwent the atrial switch procedure for correction of D-transposition of the great vessels. The early postoperative course was uneventful with normal hemodynamic measurements. However, on day 2 postoperatively hemodynamics became unstable with increasing central venous and left atrial pressure, lower mean arterial pressures, and decreasing diuresis. Chest radiography revealed bilateral pleural effusions, despite chest and pericardial drains in place. Echocardiography showed an important pericardial effusion, a mildly decreased systemic ventricular function, and a gradient of 5 mm Hg at the junction of the superior vena cava with the systemic atrium. Chest and pericardial drains were replaced surgically. Analysis of drainage fluid showed increased cellularity with a predominance of lymphocytic cells (>70%); Sudan III staining was positive. The diagnosis of a bilateral chylothorax and chylopericardium was confirmed.

Total parenteral nutrition was started. Drainage decreased over the first few days (minimum, 500 mL/24 h) but increased again to reach a maximum of 1,150 mL/24 h (230 mL · kg^-1 · 24 h^-1) on day 17 (Fig 1). Volume and electrolyte homeostasis was maintained and losses of proteins, coagulation factors, and immunoglobulins were replaced regularly. On day 17 echocardiography showed absence of superior vena cava or innominate vein thrombosis and absence of stenosis of superior vena cava–systemic atrium junction.

View larger version (22K): [in this window] [in a new window]   Fig 1. Total drainage from chest and pericardial drains (closed circles) and doses of somatostatin given by continuous infusion (open bars).

	Comment

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Chylothorax is a rare, but serious complication of cardiovascular operations for congenital heart disease. A conservative treatment strategy is currently recommended to avoid unnecessary early operation [2]. However, patients may present with massive lymph drainage, which will induce critical losses of fluid, lymphocytes, proteins, coagulation factors, and antibodies, thus increasing morbidity and mortality [1]. This is particularly true in small babies, for whom early operation is advocated [3]. Somatostatin reduces gastric, pancreatic, and intestinal secretions [5]. Somatostatin also causes a decrease of hepatic venous pressure gradient and a mild but sustained decrease of splanchnic blood flow without influencing systemic hemodynamics [5–7]. These could be useful in an attempt to decrease chyle production, as reported by Ulibarry and associates [8] in an adult patient. We obtained a similar result in an infant, in whom the introduction of somatostatin resulted in an immediate effect on chyle production, without any side effects, and operation was avoided. Controlled studies are required to confirm these observations and the effects of somatostatin treatment on morbidity and mortality.

	References

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1. Allen E.M., van Heeckeren D.W., Spector M.L., Blumer J.L. Management of nutritional and infectious complications of postoperative chylothorax in children. J Pediatr Surg 1991;26:1169-1174.[Medline]
2. LeCoultre C., Oberhänsli I., Mossaz A., Bugmann P., Faidutti B., Belli D.C. Postoperative chylothorax in children: differences between vascular and traumatic origin. J Pediatr Surg 1991;26:519-523.[Medline]
3. Azizkhan R.G., Canfield J., Alford B.A., Rodgers B.M. Pleuroperitoneal shunts in the management of neonatal chylothorax. J Pediatr Surg 1983;18:221-227.
4. Bond S.J., Guzzetta P.C., Snyder M.L., Randolph J.G. Management of pediatric postoperative chylothorax. Ann Thorac Surg 1993;56:469-473.[Abstract]
5. Kahn C.R., Shechter Y. Insulin, oral hypoglycemic agents, and the pharmacology of the endocrine pancreas. In: Gilman A.G., Rall T.W., Nies A.S., Taylor P., eds. Goodman and Gilman’s the pharmacological basis of therapeutics, 8th ed. New York: Pergamon Press, 1990:1489-1490.
6. Cirera I., Feu F., Garcia-Pagan J.C., et al. Effects of bolus injections and continuous infusions of somatostatin and placebo in patients with cirrhosis: a double-blind hemodynamic investigation. Hepatology 1995;22:106-111.[Medline]
7. Erbas T., Usman A., Erbas B., Varoglu E., Aras T., Bekdik C. Short-term effects of somatostatin analogue (SMS 201-995) on left ventricular function in healthy person: a scintigraphic study. J Endocrinol Invest 1993;16:857-861.[Medline]
8. Ulibarri J.I., Sanz Y., Fuentes C., Mancha A., Aramendia M., Sanchez S. Reduction of lymphorrhagia from ruptured thoracic duct by somatostatin. Lancet 1990;339:258.

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