A Prospective Study of Temporal Course of Phrenic Nerve Palsy in Children After Cardiac Surgery

Abstract

The aim of the study is to determine the temporal course of phrenic nerve palsy in children after cardiac surgery. Prospective electrophysiological measurement of phrenic nerve latencies and diaphragmatic action potential (DAP) amplitudes before and after operation were recorded in 59 children who underwent open heart surgery for congenital heart disease. In patients with phrenic nerve dysfunction, the procedure was repeated at 1 week and 2 weeks after the operation to determine the temporal course. In the early postoperative period, 12 patients had abnormal left phrenic nerve latencies and/or DAP amplitudes, 11 had abnormal right phrenic nerve latencies and/or DAP amplitudes, and 3 had abnormal bilateral phrenic nerve latencies and/or DAP amplitudes. After 2-week follow-up, only one of these patients had persistent left phrenic nerve palsy. Prolonged phrenic nerve latencies and decreased DAP amplitudes often occur in the early postoperative phase in children who undergo cardiac surgery. This palsy is usually transient, and electrophysiologic studies should be repeated at least up to 1 week after surgery before diaphragmatic plication is considered.

A retrospective study of diaphragmatic motion, pulmonary function, and quality-of-life following video-assisted thoracoscopic lobectomy in patients with nonsmall cell lung cancer

“…[21][22][23] Several factors may contribute to the fact that younger children are more vulnerable to respiratory complications after loss of diaphragm function: The relative weakness of the intercostal muscles, greater compliance of the chest wall, horizontal orientation of the rib cage, and increased mobility of the mediastinum. [24,25] However, most adults with UDP seems can maintain good ventilation and gas exchange at rest and during exercise, probably through compensatory mechanisms such as an increase in motor output to the intercostal muscles and the normal hemidiaphragm. Our study showed that most patients with or without UDP did experience pain, fatigue, dyspnea, and coughing.…”

Diaphragmatic paralysis in young children: A literature review

“…Compound diaphragmatic action potentials (DAPs) through phrenic transcutaneous stimulation of the phrenic nerves may be used as a prognostic tool for differentiating between a prolonged latency of the phrenic nerve recovery (neurapraxia with a propensity for recuperation) or an absent signal (axonotmesis without a propensity for recuperation) . That way, it can help in determining whether diaphragmatic function recovery can be expected.…”

“…Because of the high thoracic compliance of the chest wall in newborns, DP may have significant clinical repercussions, ranging from atelectasis to prolonged invasive mechanical ventilation …”

“…[2][3][4] Because of the high thoracic compliance of the chest wall in newborns, DP may have significant clinical repercussions, ranging from atelectasis to prolonged invasive mechanical ventilation. [5][6][7] There are no guidelines on how to manage DP in young children. In some mild cases, waiting for spontaneous recovery may be the best option, while in more severe cases, noninvasive ventilatory support using continuous positive airway pressure (CPAP) may be needed before surgery for plication of the diaphragm can be done in cases that do not recover spontaneously.…”

Diaphragmatic Paralysis Following Congenital Cardiac Surgery-A Single Center Experience

“…In a prospective study conducted by Moketal in 50 children undergoing cardiac surgery by direct percutaneous stimulation of phrenic nerve before and after operation showed 10% frequency of phrenic nerve injury which was higher than the previous retrospective reports (4) . The incidence of transient or clinically insignificant phrenic nerve palsies detected by electrophysiological measurements may be much higher (5) . Certain procedures like arterial switch operation, Fontan procedure and Blalock-Taussig shunt have shown to have a higher incidence of DP (3) .…”