Affiliation:
1. Division of Cardiovascular Surgery, Jichi Medical University, Tochigi, Japan
Abstract
Background: Chylous discharge can rarely occur after cardiac surgery through a median sternotomy. Conservative or surgical treatment might be chosen based on the amount of the discharge. Methods: We report the case of a patient who developed chylomediastinum after aortic valve replacement through a median sternotomy. A 79-year-old woman underwent aortic valve replacement through a median sternotomy for aortic valve stenosis. The thymus exhibited fatty degeneration and was divided with ligation at the mid-portion of the body without separation between the right and left lobes. Results: On the second postoperative day, 100mL of milky fluid was observed from the drainage tube of the retrosternal space after oral intake. We diagnosed the patient with chylomediastinum based on the characteristic appearance of the fluid and the relationship between the oral intake and the event. The drainage and low-fat total parenteral nutrition were continued for 1 week, leading to complete disappearance of the chylous discharge. Conclusion: Gentle and minimal exploration is required during venous snaring and thymus division for cardiac surgery through a median sternotomy, and minor chylomediastinum could be cured conservatively.