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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical and roentgenographic findings in 11 children were reviewed following development of a chylothorax after surgery for the management of congenital heart disease. The operative site in most cases was in proximity to the aortic isthmus. The pleural effusion was delayed in onset, reaccumulated rapidly after initial thoracentesis, and frequently recurred after apparent resolution. In most patients, widening of the mediastinum was noted prior to the appearance of the pleural effusion. Anatomical features of the thoracic duct and pathophysiologic concepts operative in chylothorax are reviewed and related to the clinical and roentgenographic characteristics of this entity.
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PMID:Postoperative chylothorax in children with congenital heart disease. Clinical and roentgenographic features. 126 72

Two different clinical manifestations of perigraft-reactions complicating the implantation of prosthetic aortopulmonary shunts in children with cyanotic congenital heart disease are described and discussed. The incidence of this complication in the past 5 years in our own patients was 3%. The appearance of a localized mass on the chest film surrounding the prosthesis requires the exclusion of a hematoma, aneurysm or inflammation. In the case of a massive serous pleural effusion examination of the ingredients leads to diagnosis. Concerning our own patients the fluid is identical with serum; the leakage through the prosthesis can therefore be called plasmapheresis. The claimed pathogenetic causes are discussed intensively, including a chylothorax promoting this complication in the second case. Local variations in porosity and structure of the implanted prosthesis may play a critical role in the pathogenesis of perigraft-reaction, as indicated by both our reported cases. In the event of unsuccessful observation of a localized perigraft seroma or of unsuccessful chest drainage of a massive pleural serous effusion, graft replacement and placement of a different graft material are found to have the best results.
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PMID:[Peri-graft reaction. A complication after implantation of a prosthesis shunt in children with congenital cyanotic heart defects]. 162 9

Between 1980 and 1990, 10 of 12 children with a symptomatic chylothorax after operation for congenital heart disease failed to respond to traditional medical therapy (thoracentesis, tube thoracostomy, low-fat diet). All 10 patients underwent placement of a pleuroperitoneal shunt, with complete resolution of the chylothorax in 9 patients (90%). Cardiac catheterization, performed before placement of the pleuroperitoneal shunt in 5 patients, demonstrated elevated right atrial pressure in all patients (range, 10 to 25 mm Hg). The pleuroperitoneal shunt functioned effectively in 4 patients with moderately elevated right atrial pressures (range, 10 to 16 mm Hg; median, 13.5 mm Hg) but not in 1 patient with a right atrial pressure of 25 mm Hg. Pleuroperitoneal shunting as treatment for chylothorax after operation for congenital heart disease is safe and effective, even in the face of moderate elevations in right atrial pressure.
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PMID:Pleuroperitoneal shunts for refractory chylothorax after operation for congenital heart disease. 172 46

Using pulsed Doppler ultrasound, blood flow in the inferior vena cava (IVC) was studied in 47 normal fetuses from 24 to 40 weeks of gestation and 35 abnormal fetuses, with the exception of those with arrhythmias. The abnormal fetuses were divided into 4 groups according to diagnosis, i.e., 6 cases of heart disease with hydrops (group 1), 9 cases of heart disease without hydrops (group 2), 11 cases of hydrops without heart disease (group 3), and 9 cases of other fetal diseases (group 4). By measuring the velocity of IVC blood flow, we defined a new index, the change in parallel with reverse flow velocity, and called it the preload index (PLI). In normal fetuses, PLI values ranged from 0 to 0.37 and had no relation with gestational age. The PLI was significantly higher in groups 1-3 than in normal fetuses. In group 1, the PLI was also higher than in group 2. In group 3, the PLI values in 4 cases of chylothorax, 1 of chyloascites and 1 of cytomegalovirus infection were significantly lower than in the remaining 5 cases where the cause of hydrops was undetermined. The PLI was normal in 9 fetuses with other diseases and no hydrops. The PLI was increased in conditions in which excessive preload, tricuspid regurgitation, or some kind of structural heart disease were present.
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PMID:Evaluation of the preload condition of the fetus by inferior vena caval blood flow pattern. 213 Aug 42

Traumatic chylothorax is classified as follows; postoperative and nonsurgical. We have encountered 5 cases of traumatic chylothorax, 2 after resection of lung cancer, 2 after repair of congenital heart disease and 1 after blunt chest injury. The incidence of this complication was 0.2% after surgery for cardiovascular diseases, and 0.6% for lung cancer in our institute. We carried out operation two cases successfully, one after resection for lung cancer and the other for Tetralogy of Fallot. The treatment should be determined according to the condition of the underlying diseases. We choose conservative therapy at first which is generally recommended. When chylous discharge continues, conservative therapy should be carried out when new operative skin incision is necessary for the treatment of chylothorax. Operative therapy is desirable in cases with pulmonary resection which makes dead space in pleural cavity.
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PMID:[The treatment of traumatic chylothorax]. 279 76

The development of chylothorax is a serious and often life-threatening clinical entity. Optimal management of this problem has not been well defined to date. We reviewed our experience with chylothorax in patients of all ages during the past 10 years. Ages ranged from 2 days to 69 years. The etiologies were traumatic in 17 and congenital or idiopathic in three. Six patients (five infants) were treated nonoperatively with either repeated thoracenteses or chest tube drainage. Fourteen patients (11 infants) underwent operative treatment: transthoracic thoracic duct ligation (five patients), pleuroperitoneal shunting (seven), pleuroperitoneal shunting combined with reoperation on a patient with congenital heart disease (one), and reoperation alone on a patient with congenital heart disease (one). Duration of preoperative therapy ranged from 9 days to 2 months (average 3.3 weeks). Five of six (83.3%) patients treated nonoperatively died. Of the surgically treated group, only two of 14 (14.3%) died, and 11 of the 12 survivors had resolution of the chylothorax and immediate clinical improvement. Our experience suggests that both pediatric and adult patients respond poorly to nonoperative treatment of chylothorax and that this treatment has a high mortality rate. Post-traumatic and congenital chylothorax should be treated operatively after a limited trial (1 to 2 weeks) of nonoperative therapy. Pleuroperitoneal shunting may offer a reasonable and effective alternative to thoracotomy and thoracic duct ligation.
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PMID:Chylothorax: an assessment of current surgical management. 396 5

Chylothorax is a potentially serious condition that may complicate a variety of thoracic operations, particularly cardiothoracic procedures for congenital heart disease. Conservative therapy with chest tube drainage of the chyle fluid and dietary manipulations is frequently effective. When conservative treatment fails, surgery may be necessary. In this report, the authors discuss their recent experience with fibrin glue in the management of a 600-g premature neonate who had a postoperative chylothorax. Recent trends in the management of this difficult problem are also discussed.
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PMID:Successful management of postoperative chylothorax with fibrin glue in a premature neonate. 815 71

Recent technologic advances have contributed to a renewed interest in thoracoscopic surgery. In our institution, thoracoscopy through video-assisted technology has been successfully applied to congenital heart surgery. We reviewed the charts of 45 consecutive patients (ASA physical status 11-IV) who underwent video-assisted thoracoscopic surgery (VATS) for various congenital heart defects. The mean age of the patients was 2.65 yr and the mean weight was 11.78 kg. The surgical procedures included patent ductus arteriosus interruption (n = 28) and vascular ring division (n = 8), and 9 patients had miscellaneous procedures. The most commonly used anesthetic regimen consisted of isoflurane, pancuronium, fentanyl, air, and oxygen. Seven patients were managed with one-lung ventilation, the remainder by two-lung ventilation with surgical lung retraction. Intraoperative desaturation occurred in 12 patients (26.7%) but resolved quickly with brief reexpansion of the lungs. Postoperative complications included: pleural effusions (n = 3), chylothorax (n = 2), right upper lobe atelectasis (n = 1), small pneumothorax (n = 1), and vocal cord paralysis (n = 1). Seven patients (15.5%) required conversion to a thoracotomy for insufficient exposure (n = 4) or due to concern over bleeding (n = 3). This experience with VATS in pediatric patients with congenital heart disease may provide a database for comparison with others who work with the VATS technique.
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PMID:Video-assisted thoracoscopic surgery for the treatment of congenital cardiac defects in the pediatric population. 905 29

Two children with Noonan syndrome underwent airway surgery and both experienced spontaneous chylothorax after surgery. The Noonan syndrome phenotype may include defects that significantly increase the risk of complications associated with surgery. Manifestations of Noonan syndrome may include congenital heart disease; coagulation factor deficiency; pterygium colli; and lymphangiomatosis of the pleura, lungs, and chest wall that can lead to life-threatening chylothorax. In this article, the 2 cases are presented and the relevant literature is reviewed to increase awareness of the potential problems that may be encountered in patients with Noonan syndrome. Recommendations are made regarding preoperative investigations and perioperative management to prevent complications.
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PMID:Complications following airway surgery in Noonan syndrome. 941 65

In the past 10 years there has been a growing preference for early, complete correction of congenital heart disease. The first year of operation of this cardiac unit is described. 216 operations were performed: 15% in the neonatal age group and 35% in the newborn to 1-year-old groups; 2% were palliative procedures. Mortality was 4.9%. Average stay in the ICU was 3.2 days, with a median of 2.25. Average length of ventilation was 35 hours, with a median of 17.5. Complications were: diaphragm paralysis in 13 (6%), 2/3 of which were recurrent operations; in 2 patients (0.9%) we had to plicate the diaphragm. There was severe neurological damage in 2 which deteriorated to brain death in 1. There was peripheral, reversible neurological damage in 4 (1.8%), and acute renal failure in 3%, with half of them requiring dialysis. 75% of these children died and there was superficial infection in 4.1%, deep wound infection in 1.3%, bacteremia in 4.1%, superior vena cava syndrome in 3 (1.3%) and chylothorax in 2 of them (0.9%). 1 patient (0.45%) required a ventricle-peritoneal shunt after acute viral meningitis. We are encouraged by our results to offer early complete correction to all children with congenital heart disease.
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PMID:[First year's experience of the Post-Operative Cardiac Care Unit, Schneider Children's Medical Center]. 951 91


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