The Editor,
I thank Lazopoulos et al., [1] for their interest and comments on Chylothorax after Off-pump Coronary Artery Bypass Graft Surgery: Management Strategy. They have rightly pointed out postoperative chylothorax after myocardial revascularization occurs in patients who have undergone left internal thoracic artery (LITA) graft harvesting. As the thoracic duct crosses LITA near its origin at the apex of the thorax and because of its anatomical proximity, harvesting of LITA is the principal cause of damage to lymphatic vessel or thoracic duct.[1] The use of electrocautery appears to be the chief destructive mechanism. Abnormalities of lymphatic collateral circulation are another possible cause of chylothorax.
The division of thymus by electrocautery is a probable cause as reported by Tasoglu et al.,[2] where the harvesting of LITA was not done such as valve surgery.
We have already stressed the importance of conservative management strategy as soon as the diagnosis is confirmed in the discussion.
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Conflicts of interest
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References
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