Interventional Radiology Solutions for Chylothorax After Pediatric Cardiac Surgery

First-Line Interventional Approach

Thoracic duct embolization (TDE) is the recommended first-line interventional radiology solution for persistent chylothorax after pediatric cardiac surgery, with clinical success rates of up to 97% for nontraumatic chylous effusions. 1

Initial chest X-ray is recommended to confirm pleural effusion. 2
Lymphangiography of the chest and abdomen is rated as highly appropriate (rating 8/9) for treatment planning, especially when considering minimally invasive therapy. 2

MR lymphangiography of chest and abdomen (rated 7/9) is useful to visualize lymphatic vessels without radiation exposure. 2
CT chest and abdomen with IV contrast (rated 7/9) is helpful if venous thrombosis is suspected. 2

TDE techniques include direct embolization (type I) which targets the specific site of injury, and needle disruption of thoracic duct (type II) which creates controlled leak and inflammatory reaction to divert flow. 1
Complications of TDE are generally minor (2-6%) and self-limited. 1
Long-term complications of TDE may include leg swelling, abdominal swelling, or chronic diarrhea in up to 14% of patients. 1
TDE has higher clinical success treating traumatic compared to nontraumatic chyle leaks. 1

Chylothorax after cardiac surgery increases risk of thrombosis due to loss of proteins C, S, and antithrombin III. 4, 5
Transcatheter mechanical clot removal or tPA may be necessary for pulmonary artery or superior vena caval thrombosis if they develop. 5
Higher central venous pressure is associated with increased risk of chylothorax after cardiac surgery. 5