Case report
Video-assisted thoracoscopic surgery for primary chylopericardium after orthotopic heart transplantation

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Abstract

Chylopericardium is a rare complication of cardiac surgical procedures. We describe a 41-year-old woman who underwent orthotopic heart transplantation and developed chylopericardium early in the post-operative period. Because of unsuccessful conservative treatment (pericardiocentesis, pericardial drainage, low-fat diet with medium-chain triglycerides, and total parenteral nutrition), surgical intervention was indicated and the patient successfully underwent right-sided thoracoscopic duct ligation and partial pericardiectomy (pericardial window).

Section snippets

Case report

A 40-year-old woman underwent OHT with direct bicaval anastomosis8 for hypertrophic cardiomiopathy. After an uneventful post-operative course, on the 10th post-operative day, the patient experienced anorexia, dyspnea, chest pain, and fluid retention with bilateral pre-tibial edema. Laboratory data included a white blood cell count of 9,460/mm3 with a normal differential count and a hemoglobin level of 11.8 g/dl; triglyceride and cholesterol levels were 221 mg/dl and 203 mg/dl, respectively.

Discussion

Haselbrock9 first described chylopericardium in 1888. Chylopericardium after cardiac surgery is a rare complication: its incidence is lower than the reported 0.5% to 2% incidence of chylothorax.10, 11 The cause of chylopericardium after cardiac procedures is still unclear. The possibility of a pre-existing lymphatic anomaly must always be considered,12 a direct injury of small tributary vessels of the thoracic duct, occurring during dissection of peri-aortic and perithymic structures, or an

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