Isolated chylopericardium after intrapericardial procedures: Possible role of inadvertent right efferent lymphatic trunk injury

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Chylopericardium after an intrapericardial procedure is rare, and satisfactory explanations of its possible causes are lacking. Herein, we present 4 cases of chylopericardium that developed after intrapericardial surgery, and we review the literature. Our literature review revealed 29 cases of chylopericardium that complicated intrapericardial operations, to which we added our 4 cases for analysis. The 33 surgical procedures involved repair for congenital heart disease (n=21), valve surgery (n=5), coronary artery bypass grafting (n=6), and other (n=1). Causes were verified in 7 patients: small lymphatic injury in 3 and high venous pressure or venous thrombosis in 4. Of the 26 patients with chylopericardium of unknown origin, 15 had congenital heart disease. Ten of these 15 had chromosomal abnormalities, especially trisomy 21 (Down syndrome); these patients typically had increased lymphatic permeability, which raised the likelihood of chylopericardium. Five revascularizations for coronary artery disease required harvesting of the left internal thoracic artery for reconstruction, incurring a risk of damage to the drainage site of the right efferent lymphatic trunk. In addition, all 26 patients with chylopericardium of unknown origin underwent dissection of the ascending aorta and the main pulmonary artery, near the right efferent lymphatic trunk. Inadvertent injury to the trunk during the dissection would have increased the risk of chylopericardium. Accordingly, even though the overall incidence of chylopericardium during intrapericardial procedures is low, we recommend a meticulous dissection of the ascending aorta from the main pulmonary artery.

Original languageEnglish
Pages (from-to)82-87
Number of pages6
JournalTexas Heart Institute Journal
Volume34
Issue number1
Publication statusPublished - 2007 Apr 20

Fingerprint

Pericardial Effusion
Wounds and Injuries
Dissection
Down Syndrome
Pulmonary Artery
Aorta
Heart Diseases
Venous Pressure
Mammary Arteries
Coronary Artery Bypass
Venous Thrombosis
Chromosome Aberrations
Coronary Artery Disease
Drainage
Permeability
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{b47f86c903ef4fa2b82366a330efd019,
title = "Isolated chylopericardium after intrapericardial procedures: Possible role of inadvertent right efferent lymphatic trunk injury",
abstract = "Chylopericardium after an intrapericardial procedure is rare, and satisfactory explanations of its possible causes are lacking. Herein, we present 4 cases of chylopericardium that developed after intrapericardial surgery, and we review the literature. Our literature review revealed 29 cases of chylopericardium that complicated intrapericardial operations, to which we added our 4 cases for analysis. The 33 surgical procedures involved repair for congenital heart disease (n=21), valve surgery (n=5), coronary artery bypass grafting (n=6), and other (n=1). Causes were verified in 7 patients: small lymphatic injury in 3 and high venous pressure or venous thrombosis in 4. Of the 26 patients with chylopericardium of unknown origin, 15 had congenital heart disease. Ten of these 15 had chromosomal abnormalities, especially trisomy 21 (Down syndrome); these patients typically had increased lymphatic permeability, which raised the likelihood of chylopericardium. Five revascularizations for coronary artery disease required harvesting of the left internal thoracic artery for reconstruction, incurring a risk of damage to the drainage site of the right efferent lymphatic trunk. In addition, all 26 patients with chylopericardium of unknown origin underwent dissection of the ascending aorta and the main pulmonary artery, near the right efferent lymphatic trunk. Inadvertent injury to the trunk during the dissection would have increased the risk of chylopericardium. Accordingly, even though the overall incidence of chylopericardium during intrapericardial procedures is low, we recommend a meticulous dissection of the ascending aorta from the main pulmonary artery.",
author = "Kan, {Chung Dann} and Wang, {Jieh Neng} and Wu, {Jing Ming} and Yang, {Yu Jen}",
year = "2007",
month = "4",
day = "20",
language = "English",
volume = "34",
pages = "82--87",
journal = "Texas Heart Institute Journal",
issn = "0730-2347",
publisher = "Texas Heart Institute",
number = "1",

}

TY - JOUR

T1 - Isolated chylopericardium after intrapericardial procedures

T2 - Possible role of inadvertent right efferent lymphatic trunk injury

AU - Kan, Chung Dann

AU - Wang, Jieh Neng

AU - Wu, Jing Ming

AU - Yang, Yu Jen

PY - 2007/4/20

Y1 - 2007/4/20

N2 - Chylopericardium after an intrapericardial procedure is rare, and satisfactory explanations of its possible causes are lacking. Herein, we present 4 cases of chylopericardium that developed after intrapericardial surgery, and we review the literature. Our literature review revealed 29 cases of chylopericardium that complicated intrapericardial operations, to which we added our 4 cases for analysis. The 33 surgical procedures involved repair for congenital heart disease (n=21), valve surgery (n=5), coronary artery bypass grafting (n=6), and other (n=1). Causes were verified in 7 patients: small lymphatic injury in 3 and high venous pressure or venous thrombosis in 4. Of the 26 patients with chylopericardium of unknown origin, 15 had congenital heart disease. Ten of these 15 had chromosomal abnormalities, especially trisomy 21 (Down syndrome); these patients typically had increased lymphatic permeability, which raised the likelihood of chylopericardium. Five revascularizations for coronary artery disease required harvesting of the left internal thoracic artery for reconstruction, incurring a risk of damage to the drainage site of the right efferent lymphatic trunk. In addition, all 26 patients with chylopericardium of unknown origin underwent dissection of the ascending aorta and the main pulmonary artery, near the right efferent lymphatic trunk. Inadvertent injury to the trunk during the dissection would have increased the risk of chylopericardium. Accordingly, even though the overall incidence of chylopericardium during intrapericardial procedures is low, we recommend a meticulous dissection of the ascending aorta from the main pulmonary artery.

AB - Chylopericardium after an intrapericardial procedure is rare, and satisfactory explanations of its possible causes are lacking. Herein, we present 4 cases of chylopericardium that developed after intrapericardial surgery, and we review the literature. Our literature review revealed 29 cases of chylopericardium that complicated intrapericardial operations, to which we added our 4 cases for analysis. The 33 surgical procedures involved repair for congenital heart disease (n=21), valve surgery (n=5), coronary artery bypass grafting (n=6), and other (n=1). Causes were verified in 7 patients: small lymphatic injury in 3 and high venous pressure or venous thrombosis in 4. Of the 26 patients with chylopericardium of unknown origin, 15 had congenital heart disease. Ten of these 15 had chromosomal abnormalities, especially trisomy 21 (Down syndrome); these patients typically had increased lymphatic permeability, which raised the likelihood of chylopericardium. Five revascularizations for coronary artery disease required harvesting of the left internal thoracic artery for reconstruction, incurring a risk of damage to the drainage site of the right efferent lymphatic trunk. In addition, all 26 patients with chylopericardium of unknown origin underwent dissection of the ascending aorta and the main pulmonary artery, near the right efferent lymphatic trunk. Inadvertent injury to the trunk during the dissection would have increased the risk of chylopericardium. Accordingly, even though the overall incidence of chylopericardium during intrapericardial procedures is low, we recommend a meticulous dissection of the ascending aorta from the main pulmonary artery.

UR - http://www.scopus.com/inward/record.url?scp=34247140926&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247140926&partnerID=8YFLogxK

M3 - Article

C2 - 17420799

AN - SCOPUS:34247140926

VL - 34

SP - 82

EP - 87

JO - Texas Heart Institute Journal

JF - Texas Heart Institute Journal

SN - 0730-2347

IS - 1

ER -