0
Abstract: Poster Presentations |

SYMPTOMATIC PLEURAL EFFUSION AFTER CORONARY ARTERY BYPASS REQUIRING INTERVENTION FREE TO VIEW

Adel K. Ayed, FCCP*; Chazian Chandrasekran, MB,BS, MD
Author and Funding Information

Kuwait University, Faculty of Medicine, Safat, Kuwait


Chest


Chest. 2007;132(4_MeetingAbstracts):537. doi:10.1378/chest.132.4_MeetingAbstracts.537
Text Size: A A A
Published online

Abstract

PURPOSE: The explanation for pleural effusion after cardiac surgery is unclear. The objectives of this study is to describe the patient's characteristics, pleural fluid findings, and pathologic condition in patients with large pleural effusion occurring after coronary artery bypass grafting (CABG).

METHODS: Post CABG patients who underwent therapeutic thoracocenteses and blind pleural biopsy for symptomatic pleural effusion between January 2006 and December 2006 in Chest Diseases Hospital in Kuwait were a prospectively evaluated. Chest radiographs were reviewed and information on pleural fluid findings, biopsy results was obtained.

RESULTS: During the study, 51 patients were identified; 39 men and 12 were women. All patients underwent internal mammary artery grafting. The mean left ventricular ejection fraction was 52%.All patients were dyspneic and had large (>30% of the hemithorax) effusions on chest radiograph. All effusions were persisted after 2 or more thoracocenteses. Bloody pleural effusion occurred early <3 weeks in 34 patients and nonbloody effusion occurred late > 3 weeks in 17 (p=0.01). Patients and pleural fluid characteristics are shown in table 1. Forty biopsy specimens showed pleural thickening characterized by dense fibrous tissues with associated mononuclear cell infiltration while 11 specimens showed only clotted blood. The degree of inflammation and fibrosis correlated with the interval between CABG and pleural surgery. Early post CABG patients with bloody effusions showed more inflammation with abundant lymphocytes. Late cases showed predominantly mature fibrosis (Figure). Recurrence of effusion occurred in 5/34 of patients with bloody effusion and 11/17 of patients with nonbloody effusion (p=0.002). Pleurodesis was necessary in 10 patients.

CONCLUSION: Characteristics of bloody early effusions and nonbloody effusions differ significantly, suggesting a different pathogenesis. Pleural fluid and tissue in early bloody effusion were characterized by lymphocytosis. With time, the inflammatory changes were replaced by fibrosis.

CLINICAL IMPLICATIONS: Persistent post-CABG effusion can occur and in some cases require intervention.

DISCLOSURE: Adel Ayed, No Financial Disclosure Information; No Product/Research Disclosure Information

Wednesday, October 24, 2007

12:30 PM - 2:00 PM


Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543