Is Diaphragmatic Elevation a Serious Complication of Open-Heart Surgery?

Abstract

Diaphragmatic elevation or paralysis after open-heart surgery was retrospectively analyzed in 370 consecutive operations performed on 365 adult patients. The incidence of the complication was 7.2%. It was significantly correlated with ipsilateral pleural effusion and lower-lobe atelectasis, but no predisposing or causal factors could be identified. Diaphragmatic elevation did not prolong the hospital stay. Actuarial analysis of data from follow-up chest radiograms showed normalization of the diaphragmatic position within 6 months in 44% and within a year in 90% of the patients.

Pleural effusion and chest pain after continuous interscalene brachial plexus block

“…8,9 In this setting, hypothermia-induced left phrenic nerve injury could be responsible for left hemidiaphragm elevation, left lower lobe atelectasis, and left pleural effusion. 8,9 In most cases, the nerve injury is transient and the pleural effusion resolves spontaneously or with thoracocenteses within a few months.…”

“…8,9 In this setting, hypothermia-induced left phrenic nerve injury could be responsible for left hemidiaphragm elevation, left lower lobe atelectasis, and left pleural effusion. 8,9 In most cases, the nerve injury is transient and the pleural effusion resolves spontaneously or with thoracocenteses within a few months. In postcardiac surgery patients, evidence of diaphragmatic paralysis such as pleural effusion or diaphragmatic inactivity by chest radiograph or preferably by fluoroscopy should be ruled out before initiation of a right ISB to prevent bilateral diaphragmatic paresis.…”