Iranian Heart Association Iranian Heart Journal 26 3 2025 07 01 Midodrine: A Golden Therapeutic Sword for High-Output Chylothorax 92 98 223866 EN ABU TALHA National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh. 0009-0001-8274-4526 Ibrahim Hossain National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh. Nurul Akhtar Hasan National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh. Journal Article 2024 11 19 Chylothorax, a significant complication after congenital heart surgery, adversely impacts children’s health and can lead to various morbidities, including nutritional deficiencies, prolonged ICU stays, extended hospitalizations, and an increased risk of mortality. Initial management of this condition involves nutritional strategies, such as providing gut rest and implementing a diet based on medium-chain triglycerides and low fat. Pharmacological options and surgical interventions are subsequently considered for refractory cases. This report describes a child who developed high-output chylous effusion following open-heart surgery for the correction of congenital heart disease. This effusion was successfully managed using chest drainage, nutritional intervention, and pharmacotherapy with midodrine. We hope the observations from this case report will help interventionists optimize chylothorax management and consider midodrine as a therapeutic option and a potential area of research for managing high-output chylothorax, before resorting to surgical intervention. <strong><em>(Iranian Heart Journal 2025; 26(3): 92-98)</em></strong> https://journal.iha.org.ir/article_223866_db8b15e697607d875c635c61c8c34d94.pdf