CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
AFRICA
e9
three weeks. Exploratory surgery is recommended in cases with
continued drainage after three weeks. Ligation of the thoracic
duct is the final choice of treatment for non-responding patients
to other strategies.
In our case, oral nutrition was ceased after confirmation of
the chylous drainage and TPN was started. It was stopped on
the 21st postoperative day and a diet high in protein and low in
medium-chain fatty acids was started. On the fifth day of the new
therapy, the drainage disappeared. On the 10th day, a normal oral
diet was restarted and the mediastinal drain was removed due
to lack of drainage. Thereafter, there was no increase in cardiac
silhouette on telecardiographies (Fig. 2) and no pericardial fluid
on echocardiography.
Conclusion
Our case, as far as we know, is rare and the first late-
onset chylopericardium case in the literature that was treated
conservatively without the need for surgical ligation following
combined coronary artery bypass grafting and mitral valve
replacement via median sternotomy.
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