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Steroids as a possible effective therapy in the management of large isolated chylopericardium following open heart surgery

Published online by Cambridge University Press:  27 December 2019

Ghina Fakhri ,
Mohammed Abutaqa ,
Nour Abdulhalim ,
Haytham Bou Houssein ,
Zohair Al Halees ,
Issam El-Rassi ,
Fadi Bitar Open the ORCID record for Fadi Bitar [Opens in a new window]  and
Mariam Arabi Open the ORCID record for Mariam Arabi [Opens in a new window]
Ghina Fakhri
Affiliation:
Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Mohammed Abutaqa
Affiliation:
Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Nour Abdulhalim
Affiliation:
Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Haytham Bou Houssein
Affiliation:
Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Zohair Al Halees
Affiliation:
Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Issam El-Rassi
Affiliation:
Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
Fadi Bitar
Affiliation:
Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Mariam Arabi*
Affiliation:
Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
*
Author for correspondence: M. Arabi, MD, Director of In and Outpatient Clinical Services, Head, Fetal Heart Program-Children’s Heart Center, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, PO Box: 11-0236, Beirut 1107 2020, Lebanon. Tel: 00961-1-374374; Ext: 5872/5881/5889; Fax: 00961-1-370781; E-mail: ma81@aub.edu.lb
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Abstract

Background:

Chylopericardium is the collection of lymph fluid inside the pericardial cavity. The incidence of chylopericardium is very low, as this diagnosis is rarely reported following cardiac procedures in children. While some reports were published worldwide on isolated chylopericardium after cardiac surgeries for diverse reasons, it has never been reported after repair for partial anomalous pulmonary venous return. In addition, management of this diagnosis ends up being surgical with minimal concentration on medical treatment which proved unsuccessful. We present a medical approach with corticosteroids as an effective method to treat isolated chylopericardium.

Case presentation:

In this manuscript, we present an approach to treat isolated post-operative chylopericardium in a child following repair of partial anomalous pulmonary venous return. Chylous drainage responded to corticosteroids and completely ceased. There was no need for surgical intervention.

Conclusion:

Until now, isolated chylopericardium has never been reported to occur with partial anomalous pulmonary venous return repair. A review of the literature showed that most patients follow a conservative approach consisting of diuretics and non-steroidal anti-inflammatory agents with some of them undergoing surgical re-intervention. With future research on the topic still needed, we hope that this will encourage physicians worldwide to consider administering a trial of corticosteroids as an option to treat chylopericardium.

Keywords

Chylopericardiumpartial anomalous pulmonary venous returncardiac surgerycorticosteroids
Type
Review Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1426 - 1431
Copyright
© Cambridge University Press 2019 

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Footnotes

All authors contributed equally to the literature search, data collection (including figures), and manuscript writing.

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