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

Two children who developed chylothorax after surgery for congenital heart disease are presented. The conservative management of chylothorax is reviewed and the use of immunoglobulins in the treatment of sepsis is discussed. One patient survived.
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PMID:Use of intravenous immunoglobulins as an adjunct in the conservative management of chylothorax. 1071 23

Two infants who developed chylothorax after surgery for congenital heart disease were treated successfully with subcutaneous octreotide. Apart from reducing chyle output, octreotide decreased the triglyceride content of the pleural fluid.
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PMID:Octreotide for treatment of postoperative chylothorax. 1144 12

OBJECTIVE: To review the incidence, diagnosis, and management of superior vena cava syndrome (SVCS) after surgery for congenital heart disease. DESIGN: Retrospective clinical review. All patients were computer registered. Our database includes daily follow-up. SETTING: Pediatric cardiac surgery intensive care unit in a university hospital. PATIENTS: A total of 1853 consecutive pediatric cardiac operations performed in 285 neonates and 1568 older children from 1993 to 1999 are reviewed. MEASUREMENTS AND MAIN RESULTS: The diagnosis of SVCS was suspected clinically: Color changes and swelling of the upper part of the body, confirmed by echo-Doppler, showed no or minimal flow in the superior vena cava at the beginning and collateral flow later on. Nine patients developed SVCS (0.5%). All the study patients were neonates. The prevalence of SVCS in our neonatal patients was 3.15% (nine of 285), with no SVCS in older children. Accompanying complications included chylothorax (five), hydrocephalous (four)-three of whom required ventriculoperitoneal shunt during follow-up. Thrombolytic therapy was used in five patients, and thrombectomy was used in one patient. The ventilation period ranged from 4 to 46 days (mean 20.1 days), and the length of hospital stay ranged from 37 to 120 days (mean 61.3 days). No mortality was observed during follow-up. CONCLUSIONS: SVCS is an uncommon, severe complication following neonatal cardiac surgery. It may cause chylothorax, hydrocephalus, and severe respiratory complications leading to high morbidity. Early diagnosis and thrombolytic therapy may prevent the progression of this syndrome to its subsequent sequels.
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PMID:Superior vena cava syndrome following neonatal cardiac surgery. 1279 87

Partial cavo-pulmonary bypass (termino-lateral anastomosis between the superior vena cava and one of the pulmonary arteries) is an alternative to total cavo-pulmonary bypass because of a lower morbid-mortality, or a first step to this procedure. The authors report a retrospective study of 35 patients who underwent partial cavo-pulmonary bypass between November 1985 and October 1999 at the Geneva Children's Hospital with an average follow-up of 4 years. The mean age of the patients at the time of surgery was 6.4 years. Fourteen per cent of patients had tricuspid atresia, 37% had a single ventricle, 49% had an irreparable biventricular cardiopathy and 71% had already had a previous palliative procedure. There were 2 early and 6 late deaths. The 5 year survival was 71.2% and the 10 year survival: 62.3%. The commonest early complications were arrhythmias (11/35), chylothorax (9/35) and superior vena cava syndromes (9/35). The late complications observed were arrhythmias (4/35) and suboptimal function of the partial cavo-pulmonary bypass (7/35). Eighty eight per cent of patients were symornatically improved at one year (average NYHA Class 2.8 before and 1.7 after one year), and 40% of patients were asymptomatic at this time. The haematocrit decreased after partial cavo-pulmonary bypass but tended to rise again progressively to preoperative values after 9 years. Only 49% of survivors had not been reoperated 10 years after partial cavo-pulmonary bypass. Partial cavo-pulmonary bypass is therefore associated with a temporary improvement of symptoms and polycythaemia in children with complex cyanotic heart disease: later reoperation is often required.
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PMID:[Clinical course following partial cavo-pulmonary bypass: the Geneva experience from 1985 to 2000]. 1462 31

Postoperative chylothorax compromises nutrition, immune function, coagulation, and fluid status. We report rapid short-term suppression of chylothorax by octreotide in an infant after surgery for complex congenital heart disease complicated by lymphangiectasia.
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PMID:Management of newborn lymphangiectasia and chylothorax after cardiac surgery with octreotide infusion. 1517 10

Venous thromboembolism (VTE) in pediatrics is quickly becoming a well-recognized cause of significant morbidity and mortality in children. Most children diagnosed with VTE have a serious underlying primary illness such as cancer, chronic total parenteral nutrition (TPN) dependency, or congenital heart disease. Infants and adolescents are most at risk of developing VTE, and the most significant risk factor is the presence of a central venous line (CVL). The incidence of VTE varies widely with study design and the diagnostic test used to detect thrombosis. Venography remains the gold standard diagnostic test, although ultrasound is increasingly used due to its noninvasive nature, despite concern regarding the sensitivity in upper system VTE. The treatment of uncomplicated VTE in children consists primarily of unfractionated heparin (UFH) initially, followed by oral anticoagulation or low molecular weight heparin (LMWH) for 3 months. LMWH offers many advantages over UFH due to the longer half-life, increased bioavailability, and ease of administration and monitoring in children. Acute complications of VTE in children are numerous and include pulmonary embolism (PE), chylothorax, and superior vena cava syndrome. Long-term morbidity includes recurrent VTE, postthrombotic syndrome, repeat general anesthetics for CVL placement, and eventual destruction of the upper venous system in children with repeat CVL-related VTE. Death from VTE is rare and is primarily due to PE.
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PMID:Venous thromboembolism in pediatrics. 1519 21

Chylothorax is a rare but generally severe complication of surgery of congenital heart disease. The authors report the clinical history of a young boy with complex congenital heart disease operated on several occasions and who developed severe and recurrent unilateral chylothorac after a bicavo-bipulmonary derivation. Conservative treatment followed by continuous somatostatin infusion was ineffective. Diagnostic Lipiodol lymphography was required before the chylothorax was cured. The authors describe management of this difficult case and discuss the therapeutic possibilities with reference to a brief review of the literature.
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PMID:[Diagnostic and therapeutic value of lymphography in persistent postoperative chylothorax]. 1521 62

A 8.5 year old castrated female domestic short-haired cat was presented because of progressive dyspnea, inappetence and weight loss. Special examinations revealed a chylothorax. In addition a restrictive cardiomyopathy was suspected. The cat was euthanized. The histopathologic examination of the heart confirmed the diagnosis of restrictive cardiomyopathy. The examination of the ductus thoracicus showed a intramural fibrosis with additional edema and a interstitial partly perivascular inflammation. The coherence between feline cardiopathy and chylothorax was discussed speculatively in previous reports. In this report we show a possible aetiopathology.
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PMID:[Case report. Restrictive cardiomyopathy with chylothorax in a cat: the pathogenesis]. 1557 80

Chylothorax and chylopericardium are rare conditions occurring in infants and children. Both may be traumatic or nontraumatic in origin. We reviewed our experiences with the management of sixteen pediatric cases (10 males, 6 females; 11-days to 14-years old) of chylothorax and chylopericardium from 1997 to 2003. There were fifteen cases of chylothorax (9 left, 2 right, 4 bilateral) and two cases of chylopericardium (1 isolated and 1 associated with chylothorax), and their incidences of occurrence after cardiothoracic surgery were 0.89% and 0.12%, respectively. Of the fifteen cases occurring after cardiothoracic surgery, thirteen patients had corrective or palliative surgery for complex congenital heart disease, and two patients had removal of thymolipoma and neuroblastoma, respectively. Included also in this review was an 11-day old preterm infant with hydrops fetalis and congenital heart disease who developed chylothorax. Characteristics of chylous effusion included a presence of whitish opaque fluid in the pleural cavity and the pericardial cavity, having a triglyceride content ranging from 59 to 1689 mg/dl which was higher than a plasma triglyceride, a protein content of 2.4 to 7.4 g/dl, and a presence of lymphocyte predominance. The average latent period for diagnosis of chylothorax or chylopericardium was 13 days (range 3-30). All patients were treated primarily with nutritional modification using medium-chain triglycerides (MCT) instead of long-chain triglycerides in their diet; and only a few cases needed bowel rest with total parenteral nutrition (TPN). Twelve patients completely responded to a MCT-rich diet; two cases resolved after switching to TPN and another case needed surgery for ligation of lymphatic vessels around the thymus gland. The mean duration of lymph drainage was 12.1 days (range 3-29) and the average length of time of continued conservative treatment (MCT-rich diet and TPN) was 29.8 days (range 18-47). Fourteen patients (87.25%) had good outcome, i.e. resolution from chylothorax or chylopericardium and return to normal diet. Two of the fourteen patients developed severe infections; one was diagnosed with suspected bacterial endocarditis and the other had candidemia. However, both responded well to antibacterial and antifungal drugs, respectively. One case succeeded after surgery. A case that had low compliance with dietary recommendations and required repeated placement of drainage devices died due to infection with enterococcal septicemia. Early and good compliance with MCT-rich diet is essential for achieving a favorable outcome in the management of chylothorax and chylopericardium in children.
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PMID:Management of chylothorax and chylopericardium in pediatric patients: experiences at Siriraj Hospital, Bangkok. 1592 38

Chylothorax is a rare but serious postoperative condition with a high rate of morbidity that may lead to death of children with congenital heart disease. Here we reviewed nine consecutive cases with chylothorax in infants and children following cardiac surgery from March 2002 to February 2003. Somatostatin was added to conservative treatment protocol to increase effectiveness of therapy in all cases. The duration of somatostatin therapy varied from 7 to 32 days. All cases of chylothorax were successfully treated with intravenous infusion of somatostatin as an adjunctive treatment. Even though two cases showed rebound phenomena, we avoided any surgical procedure in the nine patients who treated with conservative management combined with somatostatin. No significant side effects of somatostatin were observed. It seems that somatostatin is effective, noninvasive and safe therapeutic modality. It can be used as an adjunctive treatment to conservative management to control postoperative chylothorax in children with congenital heart disease.
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PMID:Somatostatin for postoperative chylothorax after surgery for children with congenital heart disease. 1636 2


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