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eComment: Unexpected chylopericardium and its treatment after cardiothoracic operations

Goztepe Safak Hospital, Cardiovascular Surgery Clinic, 84390 Istanbul, Turkey

Chylopericardial tamponade complicating oesophago-gastrectomy

We read with interest the article by Stewart et al. [1] in which they present an unusual case of chylous pericardial effusion following gastro-oesophageal surgery and the successful management of the patient.

Although chylothorax is a relatively common and known complication following various surgical interventions through thoracotomies, chylopericardium after intrathoracic surgery is rare. It increases postoperative hospital stay and expenses, leads to malnutrition and long-term parenteral nutrition, and patients may require invasive procedures for a definitive treatment [2].

Other than lymphatic drainage of the heart, lymph channels draining mediastinal pleura, parietal pericardium, pericardial fat and surrounding tissues unite at the lateral and posterior surfaces in the mediastinum. This anatomy should guide the physicians about pericardial fluid production as well as chylous pericardial effusions following surgical procedures interfering with the pericardium. Chylopericardium results from disruption of these channels during operation. Lymphatic fluid drainage usually occurs in the anterior mediastinum around the thymic tissue region; however, it may also ensue in the posterior mediastinum due to damage to the lymphoid structures posterior to the aorta [2]. We have recently reported a case of chylopericardium after open-heart surgery in whom the cause of the drainage was a lymphatic channel inside the mediastinum above the thymus [2].

When it occurs, dietary restriction (diet with medium-chain triglyceride content) and total parenteral nutrition are the first order treatment strategies for chylopericardium. Administration of somatostatin may decrease the amount of drainage. Explorative secondary surgery is the option for cases with chylopericardium lasting beyond three weeks. Very rarely the thoracic duct may be ligated from a lower level when explorative surgery is ineffective [2].

Once again we congratulate the authors for their interesting and challenging case. We believe their rapid management has been life-saving.

	References

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1. Stewart DJ, Chico TJA, Ackroyd R. Chylopericardial tamponade complicating oesophago-gastrectomy. Interact CardioVasc Thorac Surg 2009;8:176–177.[Abstract/Free Full Text]
2. Selimoglu O, Basaran M, Ugurlucan M, Temucin Dgus N. An interesting cause of chylopericardium after open heart surgery: a lymphatic channel. J Card Surg 2008;23:261–263.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Murat Basaran Ali Kocailik Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ugurlucan, M. Articles by Us, M. H. Search for Related Content PubMed PubMed Citation Articles by Ugurlucan, M. Articles by Us, M. H. Related Collections Related Article