Chylothorax complicates the postoperative course of patients after congenital heart surgery. Innominate vein thrombosis and stenosis have been associated with postoperative chylothorax. Revascularization and angioplasty can be accomplished using transcatheter techniques. We report our experience with this procedure for the management of postoperative chylothorax. This is a retrospective case series of patients who underwent catheter revascularization and/or angioplasty of the innominate vein following cardiac surgery at our institution from January 1, 2008 through April 9, 2014. The cardiovascular intensive care unit and cardiac catheterization laboratory at the University of Alabama at Birmingham and Benjamin Russell Hospital for Children in Birmingham, Alabama were used as settings for the study. Out of 112 patients with postoperative chylothorax, 7 (6.3%) underwent transcatheter dilation of the innominate vein for occlusion/stenosis. The median age of the cohort was 1 month (15 days-6 years); median weight was 3 kg (2.7-22.2). Diagnosis was made a median 8 days (2-20) and persisted for a median of 24 days (9-44). Most patients failed medical management (low fat diet, nothing by mouth, and/or octreotide). Cardiac catheterization occurred at a median 9 days (2-29) after chylothorax diagnosis. Median chest tube output on the day prior to procedure was 63 (12-149) cc/kg/day and decreased to 23 (0-64) cc/kg/day 2 days postprocedure (P = .01). Effusions resolved in a median of 5 days (1-16). There were no clinical complications postcatheterization. All patients who have undergone repeat angiography have maintained patency of the innominate vein. There was no mortality. Complications from chylothorax included prolong hospitalization, hyponatremia, hypoproteinemia, coagulopathy, lymphopenia, and infection. Innominate vein occlusion and stenosis associated with chylous effusion are amenable to transcatheter revascularization and/or angioplasty, consistently leading to improvement, if not full resolution of chylothorax.

OBJECTIVES: To ascertain the potential effects of hypoxemia and race on pulse oximetry in a population of patients, including those for whom hypoxemia is a normal state secondary to intracardiac mixing in an ICU setting. DESIGN: Retrospective, observational, cohort study. SETTING: A single center’s pediatric cardiac ICU (CICU). PATIENTS: Eight hundred forty-one patients undergoing bypass operations during a 52-month period (June 2019–October 2023). Predominantly, patients with congenital heart disease. The median age was 7.1 months with 58% younger than 1 year old and 88% younger than 10 years old. INTERVENTIONS: Arterial blood saturations, as measured by a hemoximeter, were recorded for all patients after bypass operations. These were time-matched, with high-fidelity, to pulse oximeter values. MEASUREMENTS AND MAIN RESULTS: The mean oximetric difference, or “pulse oximetry overestimation,” was defined as arterial oxygen saturation minus that predicted by pulse oximetry, was greater for Black than for White patients (–3.18% vs. –2.19%, p = 0.006). Regression shows a significant effect of Sao ₂ on oximetric difference (p < 0.001) and mildly significant trend for the categorical race (p = 0.03) as well as their composite interaction term (p = 0.047). Oximetric difference was exaggerated with increasing hypoxemia. At normal oxygen saturations, the oximetric difference was greater for Black when compared with White patients (p = 0.002 for patients with Sao ₂ > 94%). This effect if race is not statistically significant at other Sao ₂ ranges that are clinically important in patients with intracardiac mixing. CONCLUSIONS: This study redemonstrates effect of increasing hypoxemia on oximetric difference. Race may have an independent effect on oximetric difference. This adds to the body of literature that has previously suggested that pulse oximetry, relied upon as a vital sign, may introduce explicit race-related bias into the bedside interpretation of a patient’s clinical state.

Background: Right ventricle (RV) to pulmonary artery (PA) shunts have become the shunt of choice at many centers for use during the Norwood procedure for single ventricle palliation. Some centers have begun to use cryopreserved femoral or saphenous venous homografts as an alternative to polytetrafluoroethylene (PTFE) for shunt construction. The immunogenicity of these homografts is unknown, and potential allosensitization could have significant implications on transplant candidacy. Methods: All patients undergoing Glenn procedure at our center between 2013 and 2020 were screened. Patients who initially underwent Norwood procedure with either PTFE or venous homograft RV-PA shunt and had available pre-Glenn serum were included in the study. The primary outcome of interest was panel reactive antibody (PRA) level at the time of Glenn surgery. Results: Thirty-six patients met inclusion criteria (N = 28 PTFE, N = 8 homograft). Patients in the homograft group had significantly higher median PRA levels at the time of Glenn surgery (0% [IQR 0-18] PTFE vs 94% [IQR 74-100] homograft, P = .003). There were no other differences between the two groups. Conclusions: Despite potential improvements in PA architecture, the use of venous homografts for RV-PA shunt construction at the time of Norwood procedure is associated with significantly elevated PRA level at the time of Glenn surgery. Centers should carefully consider the use of currently available venous homografts given the high percentage of these patients who may require future transplantation.

The original version of this article unfortunately contained a mistake. The presentation of Table 2 was incorrect .The corrected table is given below.