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J Thorac Cardiovasc Surg 1998;115:734
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Thoracic duct ligation for chylopericardium

Mustafa Yüksel, MCh, DNB, FIACS, Bedrettin Yildizeli, MD

Reply to the Editor:

In the article by Musemeche and associates,Go 1 they reported the case of a 12-year-old boy with primary chylopericardium who was unresponsive to initial treatment with left thoracotomy and pericardial window followed by a no-fat diet. Two weeks later, because of recurrence of the chylopericardium, they performed a right thoracotomy with ligation of the thoracic duct.

In our letter to the Editor,Go 2 we discussed a patient with a chylopericardium who was treated by thoracoscopic thoracic duct ligation and pericardial fenestration. We think that Dr. Backer misunderstands what we meant. The sentence "no such approach to isolated chylopericardium has been described in the literature" did not mean that thoracotomy for ligation of the thoracic duct had not been described for the treatment of primary chylopericardium. What we would like to state is that there is no universally accepted method of managing primary chylopericardium, whereas there is an accepted algorithm for the therapy of chylothoraxGo 3 (chest tube insertion, a medium-chain triglyceride diet for 2 weeks, and then surgery). On the other hand, we agree with Dr. Backer that early thoracic duct ligation combined with partial pericardiectomy is the treatment of choice for primary chylopericardium.

Department of Thoracic SurgeryMamara Univeristy HospitalPK 97 Acibadem, Istanbul, Turkey References

  1. Musemeche CA, Riveron FA, Backer CL, Zales VR, Idriss FS. Massive primary chylopericardium: a case report. J Pediatr Surg 1990;25:840-2. [Medline]
  2. Yüksel M, Yildizeli B, Zonüzi F, Batirel HF. Isolated primary chylopericardium [letter]. J Thorac Cardiovasc Surg 1997:114:299.
  3. Malthaner RA, McKneally. Anatomy of the thoracic duct and chylothorax. In: Pearson FG, Deslauriers J, Ginsberg RJ, et al, editors. Thoracic surgery. 1st ed. New York: Churchill Livingstone; 1995. p. 1069-81.




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