CHYLOTHORAX SECONDARY TO OBSTRUCTION OF THE SUPERIOR VENA CAVA: A LATE COMPLICATION OF THE ATRIAL SEPTAL DEFECT REPAIR

A case of thorombosis of the superior vena cava (SVC) was complicated by unilateral chylothorax . Removal of the SVC clot and repairing its stenosis with geor-tex patch led to the prompt resolution of the chylothorax . Chylothorax is an uncommon result of obstruction of the SVC. The most reported cause is the placement of the central venous catheters.(1-6) We describe a case of chylothorax after atrial septal defect( ASD) repair with single pericardial patch. Case Report: A 30-year-old man with exertional dyspnea and cyanosis was referred to this center. The diagnosis of ASD and partial anomalous pulmonary venous connection(PAPVC)was established by transesophageal echocardiography The patient was treated with single pericardial patch repair and discharged without any complication, Postoperative echocardiography was normal. After two months the patient came back with dyspnea and swelling of the face and neck . In physical examination the patient was afebrile and had respiratory distress. He was noted to have edema and plethora of the face and signs of the right sided pleural effusion. Laboratory examination showed a hemoglobin level of 12gr/dl, white cell cunt of 4500/ml. platlets 440000/ml and normal arterial blood gas analysis. Chest x-ray confirmed a massive right sided pleural effusion. Transesophageal echocardiography (TEE) showed no residual flow across the ASD repair patch and strong evidence of SVC obstruction syndrome due to large obstructing clot in SVC by 2D, color and contrast study. (FIG-1,2) FIG-1: B-Large clot in high transesophagial short axis view of SVC FIG-1: A-Large clot in high transesophagial long axis view of SVC Chylothorax secondary to Obstruction of the Superior vena Cava: A late Complication of the Atrial Septal Defect Repair Ghaem Hospital ,Department of Cardiac surgery and Cardiology ,Mashhad Medical University,Mashhad, Iran *corresponding author.Tel:09151153737 Email address:MIRZAIEa@mums.ac.ir Archive of SID