Combined Chylopericardium and Chylothorax after Total Correction of Fallot's Tetralogy

Abstract

Chylothorax as a complication of cardiovascular surgery has a reported incidence of lower than 0.5% and is extremely rare following intrapericardial procedures. Chylopericardium in particular has a reported incidence even lower than that of chylothorax. The origin of these complications is, in either case, a direct injury to the thoracic duct or a thrombosis at the junction of the left jugular and subclavian veins obstructing thoracic duct drainage and, finally, injury to the anterior mediastinum lymphatics in the thymus area. A case is presented where chylopericardium occurred in combination with chylothorax after operation for total correction of Fallot's tetralogy. The management was conservative, consisting of evacuation of chyle and adequate protein replacement along with a low fat diet. The alternative, operative management in the form of a low ligation of the thoracic duct, should be considered if the conservative management fails after 2 weeks of trial.