Abstract
A 46-year-old man with sudden-onset chest pain was diagnosed with Stanford type A acute aortic dissection. Emergency total arch replacement was performed ; however, implantation of a left ventricular assist device (Toyobo VAS) was required 2 days later because of low cardiac output syndrome. Ten days after surgery, the patient was diagnosed with pleural effusion that increased to >1,000 ml/day. The effusion could not be controlled despite continuous drainage of a large amount of fluid. Therefore, thoracoscopic thoracic duct ligation was performed 26 days after surgery.
The pleural effusion was reduced temporarily but did not disappear completely, and frequent thoracic puncture was required. A subcutaneous injection of 100 μg of a somatostatin analog (octreotide) was administered twice a day for 67 days after surgery, and the effusion decreased 4 days later and eventually disappeared.
Octreotide has been found to be very effective for postoperative chylothorax and does not cause any side effects. It is believed that the drug is valuable even for use in patients with poor general condition.
