Objective: This study investigates possible risk factors in development of chylothorax in congenital heart surgery patients. The goal of this research is to better understand the etiology of post-operative chylothorax.
Design: This is a retrospecti ve chart review. The electronic medical records of patients that underwent a Glenn or Fontan procedure at Doembecher Children's Hospital from July 2003 to June 2006 were reviewed. Number of patients included in this study totaled 48. An objective comparison was made between pre-operative, intra-operative and post-operative data using both univariate and multivariate models.
Setting: Doembecher Children's Hospital, Oregon Health & Sciences University, Portland, Oregon.
Results: Pre-operative: Development of chylothorax was statistically more likely between ages four and six. In correspondence, chylothorax was significantly more likely if weight was between 13 and 18 kilograms. Pre-operative pulmonary artery pressure and trans-pulmonary gradient were significantly lower in the chylothorax group. Intra-operative: Patients were significantly more likely to develop a chylothorax if they underwent a Fontan procedure. Post operative: Central venous pressure was higher in the chylothorax group, although, not statistically significant. Post-operative increase in central venous pressure and trans-pulmonary gradient from baseline was significantly greater in the chylothorax group.
Conclusions: Increased risk of chylothorax after a Fontan procedure, as opposed to a Glenn procedure, may result from the increased volume of blood directed into the pulmonary vasculature. Risk of chylothorax may be related to a greater degree of increase in central venous pressure and trans-pulmonary gradient from baseline levels, in addition to isolated higher central venous pressure readings as previously hypothesized.
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