Thorac Cardiovasc Surg 2011; 59(5): 298-301
DOI: 10.1055/s-0030-1250296
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Management of Chylothorax with Octreotide after Congenital Heart Surgery

T. Tatar1 , D. Kilic1 , M. Ozkan1 , A. Hatipoglu1 , S. Aslamaci1
  • 1Department of Thoracic and Cardiovascular Surgery, Baskent University, Ankara, Turkey
Weitere Informationen

Publikationsverlauf

received May 17, 2010

Publikationsdatum:
10. März 2011 (online)

Abstract

Objective: Chylothorax is a rare complication of congenital cardiac surgery that can seriously impair the postoperative course unless treated properly. We present our treatment protocol and results with octreotide, a somatostatin analogue, in cases of chylothorax following congenital heart surgery. Material and Methods: Between March 2006 and December 2009, 12 patients were treated for chylothorax following congenital cardiac surgery. Patients consisted of five females and seven males, with a mean age of 16.6 months (7 days – 36 months). Octreotide was administrated as a continuous intravenous infusion with a dosage of 4–10 µg/kg/h. Results: Chylothorax was successfully resolved in an average of 10.3 days (7–14 days) with octreotide infusion and a strict oral diet containing medium-chain triglycerides. At a mean follow-up of 9.4 months (1–35), all patients are doing well, without any recurrence of chylothorax. Conclusion: Octreotide, a long-acting somatostatin analog, is an effective and safe agent for the treatment of postoperative chylothorax and warrants further investigation in a larger series with a greater number of patients.

References

  • 1 Markham K M, Glover J L, Welsh R J et al. Octreotide in the treatment of thoracic duct injuries.  Am Surg. 2000;  66 1165-1167
  • 2 Fahimi H, Casselman F P, Mariani M A et al. Current management of postoperative chylothorax.  Ann Thorac Surg. 2001;  71 448-451
  • 3 Kilic D, Sahin E, Gulcan O et al. Octreotide use in the management of chylothorax after cardiac surgery.  Tex Heart Inst J. 2005;  32 437-439
  • 4 Nakano A, Kato M, Watanabe T et al. OK-432 chemical pleurodesis for the treatment of persistent chylothorax.  Hepatogastroenterology. 1994;  41 568-570
  • 5 Nguyen D M, Shum-Tim D, Dobell A R et al. The management of chylothorax/chylopericardium following pediatric cardiac surgery: a 10-year experience.  J Card Surg. 1995;  10 302-308
  • 6 Au M, Weber T R, Fleming R E. Successful use of somatostatin in a case of neonatal chylothorax.  J Pediatr Surg. 2003;  38 1106-1107
  • 7 Beghetti M, La Scala G, Belli D. Etiology and management of pediatric chylothorax.  J Pediatr. 2000;  136 653-658
  • 8 Buttiker V, Fanconi S, Burger R. Chylothorax in children: guidelines for diagnosis and management.  Chest. 1999;  116 682-687
  • 9 Valentine V G, Raffin T A. The management of chylothorax.  Chest. 1992;  102 586-591
  • 10 Soto-Martinez M, Massie J. Chylothorax: diagnosis and management in children.  Paediatr Respir Rev. 2009;  10 199-207
  • 11 Le Coultre C, Oberhansli I, Mossaz A et al. Postoperative chylothorax in children: differences between vascular and traumatic origin.  J Pediatr Surg. 1991;  26 519-523
  • 12 Cerfolio R J, Allen M S, Deschamps C et al. Postoperative chylothorax.  J Thorac Cardiovasc Surg. 1996;  112 1361-1366
  • 13 Guillem P, Papachristos I, Peillon C. Etilefrine use in the management of post-operative chyle leaks in thoracic surgery.  Int Cardiovasc Thorac Surg. 2004;  3 156-160
  • 14 Roehr C C, Jung A, Proquitte H et al. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review.  Intensive Care Med. 2006;  32 650-657
  • 15 Panthongviriyakul C, Bines J E. Post-operative chylothorax in children: an evidence-based management algorithm.  J Paediatr Child Health. 2008;  44 716-721
  • 16 Nakabyashi H, Sagara H, Usukura N et al. Effect of somatostatin on the flow rate and triglyceride levels of thoracic duct lymph in normal and vagotomized dogs.  Diabetes. 1981;  30 440-445
  • 17 Bac D J, Van Hagen P M, Postema P T et al. Octreotide for protein-losing enteropathy with intestinal lymphangiectasia.  Lancet. 1995;  345 1639
  • 18 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, et al., eds. Goodman and Gilman's The pharmacological Basis of Therapeutics. 8th ed. New York: Pergamon Press; 1990: 1489-1490
  • 19 [Anonymous]. Octreotide acetate. Drug facts and comparisons.  Efacts [online]. 2004;  Available from Wolters Kluwer Health, Inc. Accessed 8/4/04
  • 20 Pratap U, Slavik Z, Ofoe V D et al. Octreotide to treat postoperative chylothorax after cardiac operations in children.  Ann Thorac Surg. 2001;  72 1740-1742
  • 21 Al-Zubairy S A, Al-Jazairi A S. Octreotide as a therapeutic option for management of chylothorax.  Ann Pharmacother. 2003;  37 679-682
  • 22 Rosti L, Bini R M, Chessa M et al. The effectiveness of octreotide in the treatment of post-operative chylothorax.  Eur J Pediatr. 2002;  161 149-150
  • 23 Tibballs J, Soto R, Bharucha T. Management of newborn lymphangiectasia and chylothorax after cardiac surgery with octreotide infusion.  Ann Thorac Surg. 2004;  77 2213-2215
  • 24 Hamdan M A, Gaeta M L. Octreotide and low-fat breast milk in postoperative chylothorax.  Ann Thorac Surg. 2004;  77 2215-2217
  • 25 Chan S Y, Lau W, Wong W H et al. Chylothorax in children after congenital heart surgery.  Ann Thorac Surg. 2006;  82 1650-1657
  • 26 Helin R D, Angeles S T V, Bhat R. Octreotide therapy for chylothorax in infants and children: a brief review.  Pediatr Crit Care Med. 2006;  7 576-579
  • 27 Allen E M, van Heeckeren D W, Spector M L et al. Management of nutritional and infectious complications of postoperative chylothorax in children.  J Pediatr Surg. 1991;  26 1169-1174

Dr. Dalokay Kilic, Thoracic Surgeon

Department of Thoracic and Cardiovascular Surgery
Baskent University

1 Cadde

06490 Ankara

Turkey

Telefon: +90 31 22 15 05 52

Fax: +90 31 22 13 23 40

eMail: dalokay7@yahoo.com