Page 23 - Journal of Structural Heart Disease Volume 3, Issue 2

Case Report
Journal of Structural Heart Disease, April 2017, Volume 3, Issue 2:49-54
DOI: http://dx.doi.org/10.12945/j.jshd.2017.010.16
Received: October 06, 2016 Accepted: October 12, 2016 Published online: April 2017
Intravascular Stent Implantation for Refractory Chylothorax Secondary to Congenital Superior Vena Cava Stenosis in an Infant
David J. Harrison, MD1*, Patrick M. Sullivan, MD2, Grant Christman, MD3, Cheryl Takao, MD2
1 Division of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, USA
2 Division of Pediatric Cardiology, Children’s Hospital Los Angeles, Los Angeles, California, USA 3 Division of Hospital Medicine, Children’s Hospital Los Angeles, Los Angeles, California, USA
Abstract
Chylothorax is a rare but dangerous cause of respira- tory failure in the pediatric population. It most com- monly presents after cardiac surgery or, alternatively, due to retrograde pressure on the thoracic duct from narrowing or obstruction in the innominate vein due to thrombus or neoplasm. We observed an unusual presentation of chylothorax in an otherwise healthy 3-month-old infant with congenital superior vena cava stenosis leading to acute respiratory collapse. After ini- tially not responding to medical therapy, the patient was successfully treated with an intravascular stent. Copyright © 2017 Science International Corp.
Key Words:
Superior • Vena • Cava pediatric • Cardiology angio- plasty interventional • Cardiology
Introduction
Respiratory failure secondary to chylothorax is a rare complication in patients with congenital heart disease [1]. In these patients, leakage of chyle into the thoracic space most commonly results from direct incidental damage to the lymphatic system during surgery or vascular obstruction in the innominate vein or superior vena cava (SVC) secondary to central
venous line-associated thrombosis, postoperative vascular stenosis, or extravascular mass e ect, all of which impede lymphatic decompression into the veins through the lymphatic duct. Very rarely, chylot- horax is reported in infants with congenital stenosis of the SVC. In previous reports of chylothorax second- ary to congenital SVC stenosis, patients have tended to present in the neonatal period and have almost always had additional complex congenital heart le- sions that increased the index of suspicion for vascu- lar anomalies as the underlying etiology [2, 3, 4]. Here, we present a unique case of an isolated congenital SVC stenosis leading to chylothorax and acute respi- ratory failure in an otherwise healthy 3-month-old. We describe the successful transcatheter stenting of the SVC and subsequent rapid resolution of the pa- tient’s e usion and symptoms.
Case Presentation
An ex-full-term and otherwise healthy 3-month- old boy was admitted to the hospital for acute re- spiratory failure in the context of a massive e usion surrounding the right lung visualized on chest x-ray. He was immediately intubated and the uid drained with a tube thoracostomy. Fluid analysis showed high
* Corresponding Author:
David J. Harrison, MD
Division of Pediatrics
Children’s Hospital Los Angeles
4650 Sunset Blvd. MS#68, Los Angeles, California 90027, USA
Tel.: +1 323 361 2122; Fax: +1 323 361 7926; E-Mail: daharrison@chla.usc.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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http://structuralheartdisease.org/