Intraoperative indocyanine green fluorescence lymphography to detect chylous leakage sites after congenital heart surgery

摘要

Chylothorax is a well-known complication that can occur after complex congenital heart surgery. The majority of patients can be treated by conservative methods, such as diet modification, total parenteral nutrition, and octreotide therapy.1 A small number of patients who do not respond to medical treatment will require surgical thoracic duct liga-tion. However, there are not many reports discussing solutions for refractory chylothorax after failure of surgical treatment. We describe a novel technique by incorporating intraoperative indocyanine green (ICG) fluorescence lymphography to detect chylous leakage. By subcutaneous injection of ICG at the groin region, we successfully detected and sutured a chylous leakage site through re-sternotomy in a 3-month-old infant with congenital heart disease who had postoperative refractory chylothorax despite numerous medical and surgical managements. The chylous drainage ceased promptly after the operation, and the method was shown to be precise and specific.