The Annals of Thoracic Surgery, Vol 32, 499-492, Copyright © 1981 by The Society of Thoracic Surgeons
Chylothorax after myocardial revascularization with internal mammary graft
DO Weber, PD Mastro and MD Yarnoz
Chylothorax following an intrapericardial cardiac operation is rare, and we
are aware of only 12 reported cases. Nine followed median sternotomy for
treatment of congenital heart disorders or acquired valvular disease; more
than expected were reoperations (23%). This report documents that this
complication may also occur following myocardial revascularization with
internal mammary graft and describes the anatomy that makes this possible.
This rare complication is important because of the high morbidity of
prolonged tube drainage and the fact that nearly half of the affected
patients underwent reoperation (5 of 13). Dilated lymphatics exuding chyle
have been found at operations undertaken to control lymph fistulas and were
located in anterior thymic tissue previously divided by electrocautery.
Awareness of the significance of lymph encountered during cardiac
operations, particularly during reoperation and near the origin of the
internal mammary artery, may alert the surgeon that the stage is set for a
disabling complication. Electrocautery may be an unreliable means of
control as lymph contains little coagulable material; suture is recommended
instead.
