Title: Role of Chemical Pleurodesis in management of Resistant Chylothorax following congenital cardiac surgery
Authors: Reyaz Ahmad Lone, Shadab Nabi Wani, Peerzada Ommid Mohamad, Pradeep Bhaskar, Ahmad bin Sallehuddin, Aslam Faris, Muhammad Riyas K Rahmath, Jiju John, Faraz Masud, Hesham Al-Saloos, Mohanad Mahmmod al-Qadi, Akhlaque Nabi Bhat
DOI: https://dx.doi.org/10.18535/jmscr/v7i5.38
Abstract
Chylothorax in children is most commonly observed following the cardiac surgery for the congenital heart diseases. A number of therapeutic interventions have been used to reduce chylothorax production and promote resolution. Management involves supportive care, parenteral nutrition, octreotide infusion and if necessary chemical or surgical pleurodesis to obtain pleural adhesion, thus obliterating chylous leaks.We report herewith 3 children with refractory chylothoraces who improved significantly following pleurodesis using Povidone Iodine. Our findings suggest that this technique can be therapeutic for children with high flow chylothorax that fail to respond to conservative therapy.
Keywords: Chylothorax, Children, Cardiac Surgery, Chemical Pleurodesis, Povidone Iodine, Drainage.
References
- Mery, C.M., 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(2): p. 678-86 e1; discussion 685-6.
- Cormack, B.E., et al., Use of Monogen for pediatric postoperative chylothorax. Ann Thorac Surg, 2004. 77(1): p. 301-5.
- Panthongviriyakul, C. and J.E. Bines, Post-operative chylothorax in children: an evidence-based management algorithm. J Paediatr Child Health, 2008. 44(12): p. 716-21.
- Staats BA, Ellefson RD, Budahn LL, et al: The lipoprotein profile of chylous and nonchylous pleural effusions.Mayo Clin Proc 1980;55:700-704.
- Straaten van HL, Gerards LJ, Krediet TG: Chylothorax in the neonatal period. Eur J Pediatr 1993;152:2-5.
- Cohan RH, Saeed M, Schwab SJ, et al. Povidone-iodine sclerosis of pelvic lymphoceles: a prospective study. Urol Radiol1988;10:203–6.
- Montalvo BM, Yrizarry JM, Casillas VJ, et al. Percutaneous sclerotherapy of lymphoceles related to renal transplantation. J Vasc Interv Radiol1996;7:117–23.
- Schutz R, Delclaux C, Balloul-Delclaux E, et al. Traitement des pyothorax et pyopneumothorax d’origine infectieuse d’évolution chronique par drainage-lavage à la polyvinylpyrrolidone iodée. Rev Mal Respir1992;9:313–17.
- Echavarria A, Pinzon V, Bares JP, et al. Intracavitary treatment of malignant pleural effusion with iodine-povidone. Rev Med Panama1991;16:69–74.
- Buttiker, V., S. Fanconi, and R. Burger, Chylothorax in children: guidelines for diagnosis and management. Chest, 1999. 116(3): p. 682-7.
- Blalock A, Cunningham RS, Robinson CS: Experimental production of chylothorax by occlusion of the superior vena cava. Ann Surg 1936;104:359-364.
- Szabo G, Magyar Z: Effect of increased systemic venous pressure on lymph pressure and flow. Am J Physiol 1967;212:1469-1974.
- Liu, J., et al., Ultrasound-guided intranodal lipiodol lymphangiography from the groin is useful for assessment and treatment of post-esophagectomy chylothorax in three cases. Int J Surg Case Rep, 2016. 29: p. 103-107.
- Brissaud O, Desfrere L, Mohsen R, Fayon M, Demarquez Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine. Arch Dis Child Fetal Noenatal 2003;88: F531-F533.
- Mitanchez D, Walter-Nicolet E, Salomen R, Bavoux F,Hubert P. Congenital chylothorax: What is the best strategy? Arch Dis Child Fetal Noenatal 2006; 91: F153-F154
- De Beer HGJ, Molet MJT, Janssen JP. Chylothorax. Neth J Med2000;56:25–31.
- Cohan RH, Saeed M, Schwab SJ, et al. Povidone-iodine sclerosis of pelvic lymphoceles: a prospective study. Urol Radiol 1988;10:203–6
- Montalvo BM, Yrizarry JM, Casillas VJ, et al. Percutaneous sclerotherapy of lymphoceles related to renal transplantation. J Vasc Interv Radiol 1996;7:117–23.
- Schutz R, Delclaux C, Balloul-Delclaux E, et al. Traitement des pyothorax et pyopneumothorax d’origine infectieuse d’e´volution chronique par drainage-lavage a` la polyvinylpyrrolidone iode´e. Rev Mal Respir1992;9:313–17.
- Echavarria A, Pinzon V, Bares JP, et al. Intracavitary treatment of malignant pleural effusion with iodine-povidone. Rev Med Panama 1991;16:69–74.
- KovacikovaL, KunovskyP, LakomyM, SkrakP, MisikovaZ, SimanJ, KostalovaLE. Thyroid hormone status after cardiac surgery in infants with delayed sternal closure and continued use of cutaneous povidone-iodine, Endocr Regul, 2003, vol. 37(pg. 3-9)
- BryantWP, ZimmermanD. Iodine-induced hyperthyroidism in a newborn, Pediatrics, 1995, vol. 95(pg. 434-436)
- Olivares-Torres CA, Laniado-LaborinR, Chavez-GarciaC, Leon-GastelumC, Reyes-EscamillA A LightRW. Iodopovidone pleurodesis for pleural effusions, Chest, 2002, vol. 122(pg. 581-583)