Abstract | OBJECTIVE:
Diaphragmatic paralysis (DP) caused by phrenic nerve injury is potentially life-threatening in infants. Phrenic nerve injury due to thoracic surgery is the most common cause of DP in children. We retrospectively analyzed incidence, surgical details, management and follow-up of our patients with DP after cardiac surgery to develop an algorithm for the management and follow-up. METHODS: Retrospective analysis of 43 patients with DP after cardiac surgery performed between 1996 and 2000. RESULTS: Median age at cardiac surgery was 1 month (range 3 days to 9 years). Incidence of DP was 5.4%. A trend towards higher incidences of DP were observed after arterial switch operation (10.8%, P=0.18), Fontan procedure (17.6%, P=0.056) and Blalock-Taussig Shunt (12.8%, P=0.10). Median time from cardiac surgery to surgical plication was 21 days (range 7-210 days). Transthoracic diaphragmatic plication was performed in 29/43 patients, no plication was done in 14/43 patients. Patients in whom diaphragmatic plication was required were younger (median age 2 months, range 21 days to 53 months versus 17.5 months, range 4 days to 110 months; P<0.001). Indications for plication were failure to wean from ventilator (n=22), respiratory distress (n=4), cavopulmonary anastomosis (n=2), and failure to thrive (n=1). All these symptoms resolved after diaphragmatic plication, however, 8/29 patients with plication and 2/14 without plication died. Cause of death was not related to diaphragmatic plication in any patient. Position of plicated diaphragm was normal in 18/21 surviving patients 1 month after plication. In 2/12 surviving patients without plication hemidiaphragm showed a normal position 1 year after surgery. The rate of pulmonary infections was not significantly different during 12-60 months follow-up. CONCLUSIONS:
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Authors | Ana L Joho-Arreola, Urs Bauersfeld, Urs G Stauffer, Oskar Baenziger, Vera Bernet |
Journal | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
(Eur J Cardiothorac Surg)
Vol. 27
Issue 1
Pg. 53-7
(Jan 2005)
ISSN: 1010-7940 [Print] Germany |
PMID | 15621471
(Publication Type: Journal Article)
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Topics |
- Algorithms
- Cardiac Surgical Procedures
(adverse effects, methods)
- Child, Preschool
- Heart Diseases
(congenital, surgery)
- Humans
- Infant
- Infant, Newborn
- Phrenic Nerve
(injuries)
- Respiration, Artificial
(methods)
- Respiratory Paralysis
(diagnosis, etiology, surgery)
- Retrospective Studies
- Thoracic Surgical Procedures
(methods)
- Time Factors
- Treatment Outcome
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