Etilefrine for Chylothorax in Patients With Congenital Heart Disease

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Chylothorax is accumulation of chyle in the pleural space and is one of the common postoperative complications of congenital cardiac surgery in children. It is challenging to manage chylothorax, and the complication is associated with increased postoperative mortality and morbidity. The definitive treatment for chylothorax has not yet been established. Currently applied managements are mostly based on previous reports, including dietary adjustment, drug administration, and surgical procedures. Some reports showed that etilefrine, a sympathetic agent, was a potential treatment option for chylothorax, although it remains unclear whether this drug is effective and safe in treating chylothorax in patients with congenital heart disease. We administered etilefrine in four patients with congenital heart disease who developed chylothorax in the perioperative period. All four patients did not respond to dietary adjustments nor steroids, but required further treatment. Three patients seemed to have some improvement in chylothorax with addition of etilefrine to conventional treatment, while one showed insufficient treatment effect. Although some cardiovascular side effects, such as hypertension and arrhythmia, had been reported, no side effects were noted in simultaneous administration of etilefrine and inotropes in our series. This is the first report on etilefrine infusion to manage chylothorax in patients with congenital heart disease. Use of this drug might be a potential option for treating chylothorax.