Incidence and Nutritional Management of Chylothorax after Surgery for Congenital Heart Diseases in Children

Authors

  • Jie Zheng, MS Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, Sichuan, China
  • Ying-Yi Chen, BS Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, Sichuan, China
  • Chun-Ying Zhang, MS Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
  • Wen-Qian Zhang, BS Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, Sichuan, China
  • Zhi-Yong Rao, MD Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, Sichuan, China

DOI:

https://doi.org/10.1532/hsf.3219

Keywords:

chylothorax, enteral nutrition with MCT, total parenteral nutrition, CHD

Abstract

Background: Chylothorax is caused by thoracic lymphatic system injury that leads to lymph extravasates in the thoracic cavity. Cardiac surgery was the most common cause. Reports comparing therapeutic effects between enteral nutrition (EN) with medium-chain triglycerides (MCT) and total parenteral nutrition (TPN) are few and inconsistent. Our study aimed to analyze the incidence of chylothorax in children in our hospital and optimum nutritional management modalities.

Methods: We retrospectively reviewed the medical records of children admitted to our hospital with a diagnosis of chylothorax from 2014 to 2018. We analyzed the incidence of chylothorax, therapeutic effectiveness, and cost effectiveness of EN with MCT or TPN.

Results: 136 patients with chylothorax after surgery for congenital heart disease (CHD) were identified from 172 patients with chylothorax (79.07%); chylothorax occurred in 5.62% of all 2420 congenital heart disease surgeries that were performed during that period. Tetralogy of Fallot (TOF), ventricular septal defect (VSD), and double-outlet right ventricle (DORV) were the most common primary diagnoses. Fontan surgery, TOF repair, and VSD repair were the most common primary procedures. We enrolled 45 patients with cured chylothorax. Nutrition support costs in the EN with MCT group (n = 28) were significantly lower than in the TPN group (n = 17) (P = .000). Time to resolution and time to removal of the drainage tube were shorter in EN with MCT versus TPN (P = .003), and the length of hospital stay was shorter (P = .032). There were no significant differences between the 2 groups in time from admission to surgery, postoperative days before diagnosing chylothorax, or length of PICU stay (P > .05).

Conclusions: The therapeutic effects of EN with MCT were significantly better than those of TPN, with lower costs. Therefore, we suggest that EN with MCT be chosen first to treat chylothorax caused by surgery with mild chest drainage volume when gastrointestinal tract function is allowed.

References

Allen EM, van Heeckeren DW, Spector ML, Blumer JL. Management of nutritional and infectious complications of postoperative chylothorax in children. J Pediatr Surg 1991;26:1169-1174.

Biewer ES, Zurn C, Arnold R, et al. Chylothorax after surgery on congenital heart disease in newborns and infants—Risk factors and efficacy of MCT-diet. J Cardiothorac Surg 2010;5:127.

Bond SJ, Guzzetta PC, Snyder ML, Randolph JG. Management of pediatric postoperative chylothorax. Ann Thorac Surg 1993;56:469-472.

Buckley JR, Graham EM, Gaies M, et al. Clinical epidemiology and centre variation in chylothorax rates after cardiac surgery in children: A report from the Pediatric Cardiac Critical Care Consortium. Cardiol Young 2017:1-8.

Büttiker V, Fanconi S, Burger R. Chylothorax in children: Guidelines for diagnosis and management. Chest 1999;116:682-687.

Chan EH, Jennifer LR, William GW, Glen SVA, John GC, Brian WM. Postoperative chylothorax after cardiothoracic surgery in children. 2010;80:1864-1870.

Chan SY, Wendy L, Wilfred HSW, Lik-cheung C, Adolphus KTC, Yiu-fai C. Chylothorax in children after congenital heart surgery. Ann Thorac Surg 2006;82:1650-1657.

Church JT, Antunez AG, Dean A, et al. Evidence-based management of chylothorax in infants. J Pediatr Surg 2017:S0022346817301598.

Cormack BE, Wilson NJ, Finucane K, West TM. Use of Monogen for pediatric postoperative chylothorax. Ann Thorac Surg 2004;77:301-305.

Densupsoontorn NS, Jirapinyo P, Wongarn R, et al. Management of chylothorax and chylopericardium in pediatric patients: Experiences at Siriraj Hospital, Bangkok. Asia Pac J Clin Nutr 2005;14:182-187.

Haines C, Walsh B, Fletcher M, Davis PJ. Chylothorax development in infants and children in the UK. Arch Dis Childhood 2014;99:724-730.

Hermon M, Tenner E, Burda G, Strohmaier W, Schlager G, Golej J. Chylothorax and chylous-like diseases in children: Clinical management. Front Pediatr 2019;7:258.

Ismail SR, Kabbani MS, Najm HK, Shaath GA, Jijeh AMZ, Hijazi OM. Impact of chylothorax on the early post operative outcome after pediatric cardiovascular surgery. J Saudi Heart Assoc 2014;26:87-92.

Lin C-H, Lin W-C, Chang J-S. Presentations and management of different causes of chylothorax in children: one medical center’s experience. Biomedicine (Taipei) 2017;7:5.

Mery CM, Moffett BS, Khan MS, et al. Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database. J Thorac Cardiovasc Surg 2014;147:678-686.

Milonakis M, Chatzis AC, Giannopoulos NM, et al. Etiology and management of chylothorax following pediatric heart surgery. J Card Surg 2009;24:369-373.

Nguyen DM, Shum-Tim D, Dobell ARC, Tchervenkov CI. The management of chylothorax/chylopericardium following pediatric cardiac surgery: A 10-year experience. J Cardiac Surg 1995;10:302-308.

Purkait R, Saha A, Tripathy I, Roy B. Congenital chylous ascites treated successfully with MCT-Based formula and octreotide. J Indian Assoc Pediatr Surg 2014;19:175-177.

Soto-Martinez M, Massie J. Chylothorax: Diagnosis and management in children. Paediatr Respir Rev 2009;10:199-207.

Winder MM, Eckhauser AW, Delgado-Corcoran C, Smout RJ, Marietta J, Bailly DK. A protocol to decrease postoperative chylous effusion duration in children. Cardiol Young 2018;28:816-825.

Yeh J, Brown ER, Kellogg KA, et al. Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient. Ann Thorac Surg 2013;96:930-936.

Published

2020-12-11

How to Cite

Zheng, J., Chen, Y.-Y., Zhang, C.-Y., Zhang, W.-Q., & Rao, Z.-Y. (2020). Incidence and Nutritional Management of Chylothorax after Surgery for Congenital Heart Diseases in Children. The Heart Surgery Forum, 23(6), E902-E906. https://doi.org/10.1532/hsf.3219

Issue

Section

Articles

Most read articles by the same author(s)