Successful use of recombinant tissue plasminogen activator (r-TPA) for management of chylothorax associated with central venous thrombosis after neonatal cardiac surgery

Postoperative chylothorax is a frequently encountered pathology occurring in up to 5% of patients undergoing surgery for repair of congenital heart disease. Neck vein thrombosis can be associated with chylothorax and may contribute to its severity and duration. Furthermore, neck vessel thrombosis resulting in permanent vessel occlusion may hinder future management, diagnostic studies and cardio-surgical interventions. In this report we are describing a neonate who developed chylothorax on the 7th post-operative day following open-heart surgery. The chylothorax was linked to venous thrombosis in the cannulated right internal jugular vein with thrombus extending to the right atrium. After using low dose tissue plasminogen activator (r-TPA) infusion, the thrombi disappeared and the chylothorax resolved with no complications.