We investigated the optimal treatment for refractory
chylothorax after pediatric cardiovascular surgery. We retrospectively reviewed the cases of 15 consecutive patients who developed
chylothorax after congenital heart surgery performed between December 2004 and November 2010. Among the 15 patients (12 male and 3 female; median age 13.9 months) who developed postoperative
chylothorax, 10 recovered with
conservative therapy, such as a
low-fat diet, medium chain
triglyceride-enriched diet, or
total parenteral nutrition. Of the remaining 5 patients who underwent surgical treatment followed by conventional
therapy, 4 showed improvement, and 1 died from
cardiac failure. Surgical treatment was performed at a median of 19 days after diagnosis of
chylothorax. Average drainage output of thoracocentesis for the first 5 days before thoracic duct
ligation was 33.1 ml/kg/day. Duration of chylous fluid drainage was significantly longer in surgical patients than in patients who recovered with
conservative therapy (p < 0.01). Surgical patients tended to be younger with lower
body weight. Significant risk factors for surgical intervention were age <4 months,
body weight <4 kg, and duration of drainage >10 days. In cases of refractory postoperative
chylothorax, surgical
therapy such as thoracic duct
ligation should be considered when discharge from the drainage tube is >30 ml/kg/day or
chylothorax is not improved within 10 days.