[HSF] postoperative pleural effusion in a TOF patient

[Anthony Rossi (CICU)]

Do you have any chemistries or cell counts on the fluid?  A chylothorax
in a patient who is NPO can appear serous.  A lymphocyte count that was
greater than 60-70% in the fluid might be diagnostic.  An echo would
also be helpful (if only to r/o a pericardial effusion), RV systolic or
diastolic dysfunction might contribute to the fluid loss.  

At this point we would probably try to maximize his ventricular function
(we prefer milrinone at higher dose ranges and either low dose
epinephrine (0.03-0.05 mcg/kg/min) or dopamine.  We would keep the
patient NPO and meticulously replace the fluid loss.  We have not found
any treatment to be particularly useful other than optimizing
hemodynamics and using diuretics to lower the RA pressure if it is
elevated.  

Hope this is a little helpful.

Anthony Rossi,MD
Director, Cardiac Intensive Care Program
Miami Children's Hospital
Miami, FL

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Giuseppe
Rescigno
Sent: Wednesday, January 10, 2007 6:22 PM
To: OpenHeart-L at lists.hsforum.com
Subject: [HSF] postoperative pleural effusion in a TOF patient

Dear Collegues,

I am faced with an unusual problem for me. A collegue of mine has
reoperated on today a16 yrs old boy who had had a previous operation for
a TOF (1991). This morning he has implanted a valved conduit (Contegra
22) on CPB and beating heart. The boy did very fine. I have been
contacted by our ICU collegues for a significant pleural effusion (after
8 hrs he has lost 2500 mL of serum) coming from both pleural spaces (esp
from the left). He had no problem preoperatively concerning total
protein and albumin concentrations. There is no anemia.
Any suggestion?

Thank you 

Giuseppe


Giuseppe Rescigno M.D.
Cardiothoracic Surgeon

Lancisi Hospital
Torrette - Ancona
Italy

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