Fontan Operasyonu Sonrası Şilotoraks Gelişen Olguda Oktreotidin Etkinliği,

Year 2014, Volume: 28 Issue: 2, 75 - 79, 01.08.2014

S. Demirpençe S. Tunca B. Güven E.a. Alayunt V. Tavlı

https://doi.org/10.18614/deutfd.69550

Abstract

Postoperative chylothorax commonly occurs following surgical repair of congenital heart disease. Chylothorax is one of the main reasons of lengthened hospitalization, morbidity and mortality amongst particularly children with single ventricle physiology. Apart from laceration of ductus thoracicus and accessory lymphatics, Fontan procedure in which systemic venous pressure exceeds thoracic ductus pressure may lead to chylothorax. Conservative therapy with diet modification and octreotide has been accepted as standard therapy of postoperative chylothorax. Here, we report a case of chylothorax arising secondary to Fontan procedure, and treated curatively with octreotide. Conclusion; chylothorax must be considered, especially in children with pleural effusion occurring after cavapulmonary anastamosis, and the octreotide should be added to conservative therapy to reduce the necessity for surgical management of chylothorax

Keywords

Child, Fontan operation, chylothorax, octreotide

Fontan Operasyonu Sonrası Şilotoraks Gelişen Olguda Oktreotidin Etkinliği,

Abstract

Postoperatif şilotoraks, sıklıkla doğumsal kalp hastalıklarının cerrahisi sonrası görülür. Şilotoraks, özellikle tek ventrikül fizyolojisi olan çocuklarda uzamış hastane yatışı, morbidite ve mortalitenin önemli nedenlerinden biridir. Ductus thoracicus ve aksesuvar lenf kanallarının hasarlanması dışında, sistemik venöz basıncın torasik duktus basıncını aştığı Fontan operasyonu şilotoraksa neden olabilir. Diyet modifikasyonlu konservatif tedavi ile oktreotid postoperatif şilotoraksın standart tedavi yöntemi olarak kabul edilmiştir. Biz bu yazıda Fontan girişimi sonrası gelişen ve oktreotid ile başarılı şekilde tedavi edilen bir şilotoraks olgusunu sunduk. Sonuç; özellikle kavapulmoner anastomoz sonrası plevral effüzyon gelişen çocuklarda şilotoraks akla gelmelidir ve cerrahi girişim gereksinimini azaltmak için konservatif tedaviye ek olarak oktreotid eklenmelidir

Keywords

Çocuk, Fontan operasyonu, şilotoraks, oktreotid

References

• Panthongviriyakul C, Bines JE. Postoperative chylotho- rax in children: an evidence-based management algo- rithm. J Paediatr Child Health 2008;44:716–721.
• Tavli V, Yılmazer MM, Güven B, Mese B, Lafci B, Gürbüz A. Octreotide treatment for chylothorax after congenital heart surgery. J Card Surg 2009;24:570-571.
• Lim KA, Kim SH, Huh J, et al. Somatostatin for posto- perative chylothorax after surgery for children with con- genital heart disease. J Korean Med Sci 2005;20:947-951.
• Sersar SI. Predictors of prolonged drainage of chylotho- rax after cardiac surgery: single centre study. Pediatr Surg Int 2011;27:811–815.
• Zuluaga MT. Chylothorax after surgery for congenital heart disease. Cur Opin Pediatr 2012;24:291-294.
• Parames F, Freitas I, Fragata J, Trigo C, Pinto MF. Oct- reotide—additional conservative therapy for postopera- tive chylothorax in congenital heart disease. Rev Port Cardiol 2009;28:799-807.
• Bond SJ, Guzzetta PC, Snyder ML, Randolph JG. Ma- nagement of pediatric postoperative chylothorax. Ann Thorac Surg 1993;56:469-472.
• Biewer ES, Zürn C, Arnold R, et al. Chylothorax after surgery on congenital heart disease in newborns and in- fants – risk factors and efficacy of MCT-diet. J Cardio- thorac Surg 2010;13:127.
• Chan EH, Russell JL, Williams WG, Van Arsdell GS, Coles JG, McCrindle BW. Postoperative chylothorax af- ter cardiothoracic surgery in children. Ann Thorac Surg 2005;80:1864–1870.
• Roehr CC, Jung A, Proquitté H, et al. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med 2006;32:650-657.
• Grosman I, Simon D. Potential gastrointestinal uses of somatostatin and its synthetic analogue octreotide. Am J Gastroenterol 1990; 85:1061-1072.
• Caverly L, Rausch CM, da Cruz E, Kaufman J. Oc- treotide treatment of chylothorax in pediatric patients following cardiothoracic surgery. Congenit Heart Dis 2010;5:573-578.
• Landvoigt MT, Mullett CJ. Octreotide efficacy in the treatment of chylothoraces following cardiac surgery in infants and children. Pediatr Crit Care Med 2006;7:245- 248.
• Chan SY, Lau W, Wong WH, Cheng LC, Chau AK, Cheung YF. Chylothorax in children after congenital heart surgery. Ann Thorac Surg 2006;82:1650-1656.
• Yoshimura N, Yamaguchi M, Oka S, et al. Long-term results after the total cavopulmonary connection. Kyobu Geka 2003;56:289-293.
• Robotin MC, Edis BD, Weintraub RG, Pawade A, Karl TR. Heart transplantation for chyloptysis after Fontan operation. Ann Thorac Surg 1995;59:1570-1571.
• Cannizzaro V, Frey B, Bernet-Buettiker V. The role of somatostatin in the treatment of persistent chylothorax in children. Eur J Cardiothorac Surg 2006;30:49-53.
• Nath DS, Savla J, Khemani RG, Nussbaum DP, Greene CL, Wells WJ. Thoracic duct ligation for persistent chy- lothorax after pediatric cardiothoracic surgery. Ann Thorac Surg 2009;88:246–251.
• Pego-Fernandes PM, Nascimbem MB, Ranzani OT, Shimoda MS, Monteiro R, Jatene FB. Video-assisted thoracoscopy as an option in the surgical treatment of chylothorax after cardiac surgery in children. J Bras Pneumol 2011;37:28-35.
• Itkin M, Krishnamurthy G, Naim MY, Bird GL, Keller MS. Percutaneous thoracic duct embolization as a treat- ment for intrathoracic chyle leaks in infants. Pediatrics 2011; 128:237–241.