Subscribe to RSS
DOI: 10.1055/s-2008-1037915
Surgical managemement of diagphragmatic paralysis following congenital cardiac surgery
Objective: Primary complex and repetetive congenital cardiac procedures are the most common cause of phrenic nerve injury. Unilateral diaphragm paralysis may produce a 50% loss of pulmonary function and is a significant cause of complicated weaning from postoperative mechanical ventilation.
Methods: Between 1990–2007 more than 2647 patients underwent congenital cardiac procedures in our institution. Diaphragmatic paralysis was diagnosed in nine infants (female: 5, male 3; age: 37–1453 days, mean: 226 days) after patients underwent surgical procedures for pulmonary atresia (n=1), single ventricle (n=1), heart transplantation (n=1), TGA (n=2), TOF (n=3), TAPVC (n=1). Indication for diaphragmatic plication was given when weaning from respiratory support was impossible. Average time for postoperatively ventilation amounted 14.5 days (range: 3 to 35 days). Diaphragmatic plication through lateral thoracotomy was performed unilaterally 7 patients and in 2 patients bilaterally.
Results: Postoperative course was uneventful in 7 patients. One patient needed prolonged respiratory support and could be weaned on postoperative day 28. The mean time period until respiratory support took 9.7 days. One patient died of cardiac failure.
Conclusions: If diaphragmatic paralysis is diagnosed after cardiac surgery in congenital heart disease we recommend diaphragmatic plication to accelerate the weaning from ventilation to reduce associated morbidity and ICU stay.