Successful Conservative Management of Postoperative Chylothorax Following Aortic Coarctation Repair in an Infant: A Case Report

Chylothorax is a rare but potentially serious postoperative complication in pediatric cardiac surgery. We report the case of a 39-day-old infant who developed postoperative chylothorax following surgical repair of severe aortic coarctation. The patient was initially discharged on postoperative day 12 in stable hemodynamic condition but was readmitted four days later with vomiting, cyanotic episodes, and respiratory distress. Chest imaging revealed a left-sided pleural effusion. Thoracentesis yielded milky fluid with markedly elevated triglycerides (17.50 g/L) and lymphocytic predominance, confirming the diagnosis of chylothorax. Conservative management included effective pleural drainage (total of 115 cc), bowel rest, lipid-free total parenteral nutrition, albumin supplementation, intravenous antibiotics, and methylprednisolone (2 mg/kg/day). Subcutaneous somatostatin (50 µg/kg every 8 hours) was initiated on day 2 and continued for 17 days to reduce lymphatic flow and support ductal healing. A specialized formula low in long-chain triglycerides (MILUPA BASIC) was introduced on day 5. The pleural effusion resolved completely, allowing drain removal by day 14. The infant was discharged on day 27 in good clinical condition. At 1-month follow-up, the child had gained 1 kg, with a normal cardiopulmonary examination. At 19 months, the patient remained healthy and symptom-free. This case highlights the effectiveness of early, structured conservative treatment and supports somatostatin-based therapy as a safe and effective alternative to surgical intervention in postoperative chylothorax