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J Thorac Cardiovasc Surg 1994;108:1156
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Chylothorax

Cardiothoracic Surgery
Mercy Hospital
Janesville, WI 53547-5003

To the Editor:

We read with interest the letter by Chaiyaroj, Mullerworth, and Tatoulis in a recent issue of the JOURNAL (1993;106:754-6) Recent experience with a similar chylothorax problem after coronary artery bypass grafting with the left internal thoracic artery (ITA) led us to make some observations.

On July 26, 1993, a 69-year-old man underwent coronary artery bypass grafting with the left ITA for an occluded left anterior descending artery that had previously been subjected to angioplasty. In addition, the distal right coronary artery was grafted with saphenous vein because of a severe proximal stenosis. The hemodynamic course was unremarkable. By the afternoon of the second postoperative day serous drainage from the hemithorax persisted, and by the third postoperative day, when dietary intake increased, the fluid became obviously milky. The drainage continued at the rate of 600 to 1500 ml per 24-hour period. On the seventh postoperative day an intraoperative transesophageal echocardiogram revealed no intrapericardial collection and therefore a left thoracotomy approach was made. This distinction was believed to be important inasmuch as the left anterior descending artery was grafted in an intramyocardial position and we wanted to be certain that no intrapericardial source existed for the persistent drainage from the tubes in the left side of the chest.

At exploration, we found diffuse lymph leakage from the proximal portion of the ITA pedicle. There was no obvious discrete point. The thoracic duct was not visualized and the diffuse lymphatic leak was repaired by sewing the proximal portion of the ITA pedicle to the endothoracic fascia and the adventitia of the subclavian vein over a 3 cm distance. The drainage ceased and postoperative recovery was rapid. The man was discharged on day 5 after the left thoracotomy and day 12 after the initial coronary artery bypass operation.

This case is at least the seventh reported case of chylothorax after myocardial revascularization. We believe that rapid identification and early surgical intervention prevent the nutritional and immunologic depletion that can occur with chylous leaks, and we would recommend early surgical intervention if these problems do not resolve within a few days.

This Article 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): Michael K. Wood Daniel J. Ullyot Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wood, M. K. Articles by Ullyot, D. J. Search for Related Content PubMed PubMed Citation Articles by Wood, M. K. Articles by Ullyot, D. J.