Management of phrenic nerve injury post-cardiac surgery in the paediatric patient

Abstract

Background: Phrenic nerve injury is a common complication of cardiac and thoracic surgical procedures, with potentially severe effects on the health of a child. This review aims to summarise the available literature on the diagnosis and management of PNI post-cardiac surgery in paediatric patients with CHD. Main body: The presence of injury post-surgery can be difficult to detect and may present with non-specific symptoms, emphasising the importance of an effective diagnostic strategy. Chest X-ray is usually the first investigation for a suspected diagnosis of PNI, which is usually confirmed using fluoroscopy, ultrasound scan, or phrenic nerve stimulation (gold standard). Management options include supportive ventilation and/or invasive diaphragmatic plication surgery. While the optimal timing of plication surgery remains controversial, it is now the most widely accepted treatment for PNI in children post-CHD surgery, especially for very young patients who cannot be weaned off supportive ventilation. Further research is needed to determine the optimal timing of surgical intervention for positive outcomes and to explore the benefits of using minimally invasive surgical techniques in children. Conclusion: PNI is a common and serious complication of CHD surgery, therefore, its diagnosis and management in the paediatric population are of major importance. Further research is needed to determine the optimal timing of surgical intervention for positive outcomes and to explore the benefits of using minimally invasive surgical techniques in children.

Right phrenic nerve palsy following long-gap esophageal atresia and tracheoesophageal fistula repair

“…Phrenic nerve is a motor nerve supplying the diaphragm, enabling/aiding respiration. [ 1 ] Phrenic nerve injury (PNI), especially in neonates and infants who are primarily diaphragmatic breathers, may lead to respiratory failure.…”

“…Cardiothoracic surgeries in neonates are known to cause PNI, accounting for 64% of cases. [ 1 ] PNI after repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) is rare with only a few cases reported in the past. [ 2 3 4 5 ] Here, we report possibly the first diagnosed case of right PNI following repair of long-gap EA and TEF from India.…”