ĐẶC ĐIỂM TRÀN DỊCH DƯỠNG TRẤP MÀNG PHỔI SAU PHẪU THUẬT BỆNH TIM BẨM SINH TẠI BỆNH VIỆN NHI ĐỒNG 2

Abstract

Background: In recent years, early surgical correction of congenital heart diseases has made significant progress, improving the quality of life for pediatric patients. However, mortality due to postoperative complications remains a concern and is of great interest to both intensivists and cardiologists. Among postoperative cardiac complications, chylothorax is one of the conditions associated with a significant increase in mortality rate, prolonged hospital stays, extended intensive care unit admissions, prolonged mechanical ventilation, and more. In Vietnam, postoperative chylothorax following congenital heart disease surgery in children has not been widely studied. Similarly, at Children's Hospital 2, there has been no research on this condition. Methods: A case series study, retrospectively from January 2015 to January 2024, and prospectively from February 2024 to June 2024, including patients diagnosed with chylothorax after congenital heart disease surgery who meet the inclusion and exclusion criteria. Results: A total of 41 patients were included in the study. The male-to-female ratio was 1.28:1. The median age was 45 days, with the neonatal age group accounting for the highest proportion. The most common congenital heart diseases, in order, were transposition of the great arteries, aortic arch hypoplasia, total anomalous pulmonary venous return, and ventricular septal defect. The most frequent surgical approach was biventricular repair without aortic arch reconstruction (65.85%), while the Glenn procedure had the lowest proportion (14.63%). The median time from surgery to the diagnosis of chylothorax was 7 days. Most patients had bilateral chylous effusion and already had a central venous catheter in the internal jugular vein. Hypoalbuminemia and hyponatremia were commonly observed. The mortality rate was 21.95%, with a median duration of mechanical ventilation of 18 days, a median chest tube drainage duration of 25 days, and a median hospital stay of 47 days. Conclusion: Postoperative chylothorax after congenital heart disease surgery is commonly seen in neonates, typically occurring within the first postoperative week. It is most frequently associated with congenital heart defects such as transposition of the great arteries, aortic arch hypoplasia, total anomalous pulmonary venous return, and ventricular septal defect, especially in patients with pre-existing internal jugular vein catheters. Hypoalbuminemia, hyponatremia, and infections are common complications in these patients.