Chylothorax continues

So, the reason why fluid is accumulating in Jesse's chest (pleural space around his lungs) is because of the continuing chylothorax. This has not resolved on its own, despite trying octreotide (a hormone) and a special formula (Portagen). The next step is for Jesse to be placed on TPN (Total Parenteral Nutrition) - meaning he will be off bottles all together and totally fed intraveneously. This will last for the minimum of a week and maybe a month or more.

Below I've pasted a very good article about chylothorax that I found on the internet at http://tchin.org/resource_room/c_art_15e.htm I hope it's helpful to all of us in understanding what's going on.

Kristan is going to try to get on tonight to update everyone more.

By the way, Jesse's oxygen has been turned down again & he is breathing well.

Thank you everyone for your continued prayers.

Aunt Kim

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Chylothorax is the accumulation of chyle in the pleural (lung) space. Chyle is usually a milky fluid comprised of lymph drainage, which carries fat, protein and white blood cells (lymphocytes). It occurs after injury to or obstruction of the thoracic duct. Injury to the thoracic duct during cardiovascular surgery occurs because of its proximity to the great vessels (aorta and pulmonary artery) in the chest, where the duct crosses from right to left. Most cases of chylothorax after surgery for congenital heart disease have occurred after non-open heart procedures, mainly subclavian-pulmonary artery shunt procedures, resection of coarctation of the aorta, and ligation of patent ductus arteriosus.

Symptoms of chylothorax are related to the amount of fluid present and the rate at which it accumulates and may include fatigue, shortness of breath at rest or on exertion, heaviness, and discomfort on the affected side. An initial trial of conservative therapy is indicated, since spontaneous closure can occur. Removing chyle from the pleural space is best accomplished by chest tube placement for continuing draining. This allows full re-expansion of the lung, which closes the lymph connection (fistula) by the lung’s compression effects. In order to maintain adequate nutrition while reducing lymph flow, it is recommended that the diet be changed to limit the fat source to medium-chain triglycerides (fats that are directly absorbed from the gut into the blood stream without having to go through the lymph system). Alternatively, the patient may need to take nothing by mouth and receive total parenteral nutrition (TPN) by receiving all nutrition through an IV or central line for many weeks. Since flow of chyle is minimized only when the gastrointestinal tract is completely at rest, others prefer to stop oral feedings altogether. The drainage of chyle usually slows or stops within 7 days after tube drainage and with changing of the diet to reduce lymph flow. If this does not occur, more aggressive action such as surgery may be recommended.