Impact of diaphragmatic paralysis after cardiothoracic surgery in children

Leeuw, Maaike; Williams, Jasmine M.; Freedom, Robert M.; Williams, William; Shemie, Sam D.; McCrindle, Brian W.

doi:10.1016/s0022-5223(99)70190-x

Cited by 90 publications

(94 citation statements)

References 22 publications

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“…On the ipsilateral side, the diaphragm moves paradoxically as it cannot resist negative intrapleural pressure. This results in decreased functional residual capacity, alveolar collapse and atelectasis, which causedyspnea, recurrent reintubations, failure to wean from mechanical ventilation, retained secretions and pneumonia [8][9][10]14]. The majority of our patients (64.3%) who underwent diaphragm plication following cardiac surgery were under 1 year of age.…”

Section: Discussionmentioning

confidence: 99%

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Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management

et al. 2006

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Diaphragmatic paralysis (DP) after cardiac surgery is an important complication especially in infants. We analyzed the incidence, clinical course, surgical management and follow up of the patients with DP, retrospectively. Between 1996 and 2005, 3,071 patients underwent cardiac surgery. Total number of patients with DP was 152 (4.9%). Out of 152 patients, 42 were surgically treated with transthoracic diaphragm plication (1.3%). The overall incidence of diaphragm paralysis was higher in correction of tetralogy of Fallot (31.5%), Blaloc-Taussig (B-T) shunt (11.1%) and VSD closure with pulmonary artery patch plasty (11.1). The incidence of DP which require plication was higher in B-T shunt (23.8%) arterial switch (19%) and correction of tetralogy of Fallot (11.9%). Mean and median age at the time of surgery were 17.8 +/- 3.6 and 6 months, respectively. Median time from cardiac surgery to surgical plication was 12 days. Indications for plication were repeated reintubations (n = 22), failure to wean from ventilator (n = 12), recurrent lung infections (n = 5) and persistent respiratory distress (n = 3). Mortality rate was 19.1%. Being under 1 year of age, pneumonia and plication 10 days after mechanical ventilation were associated with higher incidence mortality (P < 0.05). Phrenic nerve injury is a serious complication of cardiac surgery. It is more common after some special procedures. Spontaneous recovery is very rare. Being under 1 year of age, plication after 10 days from the surgery and pneumonia are major risk factors for mortality even in plicated patients. Transthoracic plication is helpful if performed early.

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Section: Discussionmentioning

confidence: 99%

“…It is accepted that procedures in congenital cardiac surgery are the major causes of DP with an incidence ranging from 0.3 to 12.8% [2,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management

et al. 2006

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“…In our study nearly half (48%) of the patients were neonates and 85% of the patients who underwent plication were less than 1 year old.Morbidity associated with DP is more significant in smaller infants and neonates. This group of patients require higher index of suspicion and more aggressive management (6) . In patients with fontan physiology, diaphragmatic paralysis causes a reduction or loss of inspiratory augmentation of pulmonary flow.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the current reports suggest surgical intervention in smaller patients if symptomatic and remain on ventilator for more than 2 weeks (6,12,13) . Plication of diaphragm has been shown to be safe and useful procedure to improve the ventilation in these patients (14) and video assisted plication has been shown to offer more rapid recovery with less morbidity (15) .…”

Section: Discussionmentioning

confidence: 99%

Diaphragmatic Paralysis Following Congenital Cardiac Surgery-A Single Center Experience

Lone¹

2017

jmscr

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“…1,2 Arterial hypoxaemia can result from ventilation-perfusion mismatch at the base of the lungs, while hypercapnia is due to decreased tidal volume and minute ventilation. 3 Cardiovascular surgery is the most common cause of acquired diaphragmatic paralysis, accounting for approximately 64% of phrenic nerve injuries.…”

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confidence: 99%

Bilateral Diaphragmatic Paralysis Following Paediatric Cardiac Surgery: Experience of four cases at the Royal Hospital, Muscat, Oman

Al-Hanshi¹,

Al-Ghafri²

2017

SQUMJ

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Bilateral diaphragmatic paralysis (BDP) is a rare complication of paediatric cardiac surgery. We report four children who developed BDP following cardiac surgery who were managed at the Royal Hospital, Muscat, Oman, between 2009 and 2014. All four children suffered severe respiratory distress soon after extubation and required re-intubation within two hours. In addition, all of the children underwent a tracheostomy as an interim method for ventilation. The four children were successfully weaned from positive pressure ventilation following the functional recovery of at least one side of the diaphragm.

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Impact of diaphragmatic paralysis after cardiothoracic surgery in children

Cited by 90 publications

References 22 publications

Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management

Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management

Diaphragmatic Paralysis Following Congenital Cardiac Surgery-A Single Center Experience

Bilateral Diaphragmatic Paralysis Following Paediatric Cardiac Surgery: Experience of four cases at the Royal Hospital, Muscat, Oman

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