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Intraoperative Indocyanine Green Fluorescence Lymphography to Detect Chylous Leakage Site after Congenital Heart Surgery
Te-I Chang, Yih-Sharng Chen, Shu-Chien Huang.
National Taiwan University Hospital, Taipei, Taiwan.
OBJECTIVE: To demonstrate a novel way of intraoperative fluorescence lymphography used for refractory chylothorax in a postoperative congenital heart disease patient.
METHODS: Intraoperative indocyanine green fluorescence angiography has been proved in its usefulness in many fields of surgery such as ophthalmic chorioangiography, coronary angiography, and microscopic neurosurgery. We incorporated a novel intraoperative indocyanine green (ICG) fluorescence lymphography via subcutaneous injection of ICG at groin region to guide for the detection of chylous leakage during a resternotomy.
RESULTS: A male baby presented with endocardial cushion defect and severe coarctation of aorta received aortoplasty and pulmonary artery banding soon after birth. Massive chylothorax (800ml/day) developed after his corrective surgery at the age of 3 month. Low-fat diet and even total parenteral nutrition failed. Right-sided thoracic duct ligation, and later, left-sided thoracic duct ligation were performed but refractory chylothorax (~300ml/day) remained. By incorporating novel intraoperative indocyanine green (ICG) fluorescence lymphography, we successfully detected and sutured a chylous leakage site through re-sternotomy. His chylous drainage stopped promptly after the operation.
CONCLUSIONS: The new application, proved to be very sensitive for identifying even minor leakage sites with great precision and specificity. It could be a salvage option in treating patients with formidable chylothorax refractory to either conservative treatments or thoracic duct ligation 
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