Onur DOYURGAN, Osman AKDENİZ, Yiğit KILIÇ, Ahmet Kuddusi İRDEM, Eşe Eda TURANLI, Rezzan Ezgi EKİN, Süleyman GETER, Mehmet Nur TALAY

Konjenital Kalp Cerrahisi Sonrasında Şilotoraks Meydana Gelen Çocuklarda Medikal Tedavi Yaklaşımı

Amaç: Konjenital kalp cerrahisini takiben görülen şilotoraks erken tanı ve tedavi gerektiren potansiyel olarak ciddi bir komplikasyondur. Bu çalışmanın amacı konjenital kalp cerrahisi sonrası erken dönemde ortaya çıkan şilotoraks tedavisi ile ilgili deneyimlerimizi gözden geçirmektir. Materyal ve metod: Hastanemizde Mart 2017-Şubat 2023 tarihleri arasında konjenital kalp hastalığı nede-niyle ameliyat yapılan 1215 hastadan postoperatif şilotoraks gelişen hastaların kayıtları retrospektif olarak incelendi. Bulgular: Çalışmaya postoperatif şilotoraks gelişen 11’i erkek 17 hasta dahil edildi. Ortanca yaş 7.5 ay, ortanca vücut ağırlığı 6.4 kilogram olarak saptandı. Cerrahi prosedürler aort koarktasyonu tamiri (beş), Glenn operas-yonu (dört), Fallot tetralojisi tamiri (iki), Fontan operasyonu (bir), atriyoventriküler kanal defekti tamiri (bir), ventriküler septal defekt kapatılması (bir), vasküler ring tamiri (bir), patent duktus arteriyozus ligasyonu (bir) ve bir hastada sağ modifiye Blalock-Taussig şantı idi. Lenfatik drenaj miktarı ortanca 4.6 ml/kg/gün (2.3 ile 8.1 ml/kg/gün) ve lenfatik drenaj süresi ortanca 16.5 gün (5 ile 38 gün) arasındaydı. Şilöz sıvının boşaltılmasının ardından total parenteral nutrisyon ve enteral orta zincirli trigliserid diyeti verildi. On dört (%82.4) hastada ek olarak ‘oktreotid’ kullanıldı. Şilöz sıvı drenajının sona ermesini takiben hastalara 6 hafta orta zincirli trigliserid diyeti verildi. Bir hasta sepsis nedeniyle kaybedildi. Sonuç: Şilotoraks kalp cerrahisi sonrasında morbiditeye neden olan bir komplikasyondur. Kliniğin belirlediği doğru bir algoritma izlendiğinde morbidite azaltılabilir.

Anahtar Kelimeler:

şilotoraks, doğumsal kalp kusurları, kalp cerrahisi, postoperatif dönem

Medical Treatment Approach in Children with Chylothorax After Congenital Heart Surgery

Background: Chylothorax following congenital heart surgery is a potentially serious complication that requi-res early diagnosis and treatment. The aim of this study is to review our experience with the treatment of chylothorax occurring in the early period after congenital heart surgery. Materials and Methods: The records of patients who developed postoperative chylothorax among 1215 patients who underwent surgery for congenital heart disease in our hospital between March 2017 and February 2023 were retrospectively reviewed. Results: Seventeen patients, 11 of whom were male, who developed postoperative chylothorax were inclu-ded in the study. The median age was 7.5 months, and the median body weight was 6.4 kilograms. Surgical procedures were aortic coarctation repair (five), Glenn operation (four), Tetralogy of Fallot repair (two), Fontan operation (one), atrioventricular canal defect repair (one), ventricular septal defect closure (one), vascular ring repair (one), patent ductus arteriosus ligation (one), and right modified Blalock-Taussig shunt in one patient. The median amount of lymphatic drainage was 4.6 ml/kg/day (2.3 to 8.1 ml/kg/day) and the median lymphatic drainage time was 16.5 days (5 to 38 days). After the chylous fluid drained, total parenteral nutrition and enteral medium-chain triglyceride diet were given. Octreotide was used additionally in 82.4% of the patients. After the chylous fluid drainage stopped, the patients were given a medium chain triglyceri-de diet for 6 weeks. One patient died due to sepsis. Conclusions: Chylothorax is a complication that causes morbidity after cardiac surgery. Morbidity can be reduced if a correct algorithm determined by the clinic is followed. Key Words: Chylothorax, Congenital heart defects, Heart surgery, Postoperative period

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