Phrenic nerve conduction study in demyelinating neuropathies and open-heart surgery

Cruz-Martínez, A; Armijo, A; Fermoso, A; Moraleda, Susana; Maté, I; Marin, Marco Antonio

doi:10.1016/s1388-2457(00)00250-9

Cited by 27 publications

(12 citation statements)

References 26 publications

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“…However, we observed no nerve injury in our beating heart CABG group, most of whom were LIMA harvested. Moreover, our beating heart results do not support the opinion that sternal retraction causes phrenic nerve injury [6,12]. …”

Section: Discussioncontrasting

confidence: 77%

Electrophysiological evaluation of phrenic nerve injury during cardiac surgery – a prospective, controlled, clinical study

et al. 2004

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BackgroundAccording to some reports, left hemidiaphragmatic paralysis due to phrenic nerve injury may occur following cardiac surgery. The purpose of this study was to document the effects on phrenic nerve injury of whole body hypothermia, use of ice-slush around the heart and mammary artery harvesting.MethodsElectrophysiology of phrenic nerves was studied bilaterally in 78 subjects before and three weeks after cardiac or peripheral vascular surgery. In 49 patients, coronary artery bypass grafting (CABG) and heart valve replacement with moderate hypothermic (mean 28°C) cardiopulmonary bypass (CPB) were performed. In the other 29, CABG with beating heart was performed, or, in several cases, peripheral vascular surgery with normothermia.ResultsIn all patients, measurements of bilateral phrenic nerve function were within normal limits before surgery. Three weeks after surgery, left phrenic nerve function was absent in five patients in the CPB and hypothermia group (3 in CABG and 2 in valve replacement). No phrenic nerve dysfunction was observed after surgery in the CABG with beating heart (no CPB) or the peripheral vascular groups. Except in the five patients with left phrenic nerve paralysis, mean phrenic nerve conduction latency time (ms) and amplitude (mV) did not differ statistically before and after surgery in either group (p > 0.05).ConclusionsOur results indicate that CPB with hypothermia and local ice-slush application around the heart play a role in phrenic nerve injury following cardiac surgery. Furthermore, phrenic nerve injury during cardiac surgery occurred in 10.2 % of our patients (CABG with CPB plus valve surgery).

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Section: Discussioncontrasting

confidence: 77%

Electrophysiological evaluation of phrenic nerve injury during cardiac surgery – a prospective, controlled, clinical study

et al. 2004

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“…The tests were performed with Viking EMG apparatus (Nicolet). Phrenic nerve conduction was assessed as described elsewhere (Cruz-Martinez et al, 2000). Latency was determined from the stimulus artifact to the onset of the negative peak.…”

Section: Electrophysiological Respiratory and Pathological Analysismentioning

confidence: 99%

Autonomic and respiratory dysfunction in Charcot–Marie–Tooth disease due to Thr124Met mutation in the myelin protein zero gene

Stojkovic

Seze

Dubourg³

et al. 2003

Clinical Neurophysiology

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Objective: To report the clinical and electrophysiological characteristics of a family presenting Charcot -Marie-Tooth disease (CMT) associated with autonomic nervous system disturbances.Methods: We studied nerve conduction values, postural adaptation, sympathetic skin reflex, the variation in heart rate by the Valsalva ratio and pupillometry in 7 members of a French family in which CMT due to a Thr124Met mutation in the myelin protein zero (MPZ) gene was diagnosed.Results: Clinical and laboratory evidence of autonomic nervous system disturbances were found in the affected individuals. The clinical phenotype was characterized by sensorimotor peripheral neuropathy, defined as axonal type by electrophysiological studies, and was associated with severe pain, bladder dysfunction, sudorimotor disturbances and abolished pupillary reflex to light. Moreover, two patients had severe restrictive respiratory insufficiency requiring noninvasive mechanical ventilation.Conclusions: Our study demonstrates that autonomic disturbances may be one of the major clinical signs associated with CMT secondary to MPZ gene mutation in codon 124. Testing of pupillary reflex allows the discrimination of affected and unaffected subjects in our family. However, involvement of the autonomic nervous system in this type of neuropathy is unclear and further studies are required to elucidate the role of the MPZ gene in the autonomic nervous system.

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“…Electrophysiological signs of damaged PN have been detected in patients diagnosed as having hereditary motor and sensory neuropathy I (HMSN I) [1] and GuillainBarré syndrome [3]. Cases of acute respiratory failure have been described in a small series of CIDP patients with altered PN conduction [5,6,15]; however, clinical signs of respiratory failure were associated with these EDX abnormalities.…”

Section: Tablementioning

confidence: 99%

“…Furthermore, abnormal values of conduction velocity of PN, even in the absence of respiratory dysfunction, have been reported in patients with acquired [3] or inherited neuropathies [1], suggesting that PN conduction studies may be able to disclose subclinical changes. Therefore, whether or not a PN involvement may be able to predict or cause respiratory failure in CIDP patients is a question still to be answered.…”

Section: Introductionmentioning

confidence: 99%

Subclinical electrophysiological alterations of phrenic nerve in chronic inflammatory demyelinating polyneuropathy

et al. 2005

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Alterations of the phrenic nerve (PN) and pulmonary function tests (PFTs) have been described in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). This study was aimed at assessing the relationship between PN and respiratory function in CIDP patients without clinical signs of respiratory failure. Bilateral PN and right median nerve conduction studies were carried out along with blood gas analysis and PFTs: maximal inspiratory pressure; maximal expiratory pressure; forced vital capacity. The amplitude of the compound muscle action potential of the PN was seen to be altered in 19/24 (79%) patients and latency in 22 (92%). Eighteen patients (75%) showed at least one abnormal PFTs or CO2 partial pressure value. Electrophysiological alterations of the PN were observed in a high percentage of the CIDP patients studied. No statistically significant correlation was observed between PN and PFTs alterations.

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Phrenic nerve conduction study in demyelinating neuropathies and open-heart surgery

Cited by 27 publications

References 26 publications

Electrophysiological evaluation of phrenic nerve injury during cardiac surgery – a prospective, controlled, clinical study

Electrophysiological evaluation of phrenic nerve injury during cardiac surgery – a prospective, controlled, clinical study

Autonomic and respiratory dysfunction in Charcot–Marie–Tooth disease due to Thr124Met mutation in the myelin protein zero gene

Subclinical electrophysiological alterations of phrenic nerve in chronic inflammatory demyelinating polyneuropathy

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