Post cardiac surgery phrenic nerve palsy: value of plication and potential for recovery

Onna, I.; Metz, R.; Jekel, Lilian; Woolley, Sarah; Wal, H. J. C. M. Van De

doi:10.1016/s1010-7940(98)00147-x

Cited by 54 publications

(70 citation statements)

References 14 publications

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“…Respiratory condition is one of the most important factors influencing mortality and morbidity especially in infants. DP after cardiac surgery is an important complication with negative effects on pulmonary situation [1][2][3][4][5][6][7][8][9]. Reports of the prevalence of DP after cardiac operations in children vary from 0.3 to 12.8% [3, 6, 10-12, 16, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Diaphragmatic paralysis (DP) due to phrenic nerve injury after congenital cardiac surgery is an important respiratory complication resulting with respiratory insufficiency, lung infections, prolonged hospital stay time and even death [1][2][3][4][5][6][7][8][9]. 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%

“…This situation is the major cause of lung infections and related complications such as atelectasis and recurrent pneumonia [3][4][5]. Great majority of older children have the advantage of overcoming DP as they use their intercostal muscles for respiration when compared with infants [6][7][8][9].…”

Section: Introductionmentioning

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%

Section: Introductionmentioning

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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“…12 A retrospective study by Dagan et al identified nine BDP cases among 3,214 children who had undergone cardiac surgery, resulting in an incidence of 0.28%. 13 Zhang et al reported four cases of BDP out of 47 patients with diaphragmatic paralysis.…”

Section: Discussionmentioning

confidence: 99%

“…This timing is similar to that reported by other researchers. 12,13 In cases of BDP, ultrasonography and/or fluoroscopy findings are considered diagnostic. 5,9,10,[15][16][17][18] All BDP diagnoses in the current series were based on one of these radiological modalities.…”

Section: Discussionmentioning

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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The respiratory system in pediatric chronic heart disease

Apostolopoulou

2017

Pediatric Pulmonology

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Cardiovascular disease in the pediatric population closely affects the respiratory system inducing water retention in the lungs and pulmonary edema, airway compression by cardiovascular structures, restrictive pulmonary physiology as a result of hemodynamic changes and surgical repair, susceptibility to respiratory infections, development of pulmonary hypertension, thrombosis, or hemorrhage. Chronic heart failure and congenital heart disease are characterized by various respiratory manifestations and symptoms mimicking lung disease, which are frequently difficult to diagnose and treat. Pulmonary function is multiply affected in pediatric heart disease with mostly restrictive but also obstructive and diffusion abnormalities. Patients with Fontan circulation represent a separate group with slow, passive pulmonary blood flow and distinct pathophysiology with low cardiac output heart failure, restrictive lung pattern, increased thromboembolic complications and rare conditions such as protein losing enteropathy and plastic bronchitis. Distinguishing between cardiovascular and pulmonary symptoms may be challenging in the growing population of pediatric and adult survivors of congenital heart disease and understanding of the relationship of the two systems in heart disease is crucial for the optimal management of these patients.

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Post cardiac surgery phrenic nerve palsy: value of plication and potential for recovery

Abstract: Prospective screening for PNP revealed an incidence in children younger than 1 year of 6%. Early plication substantially reduces the duration of ventilation, with its associated reduced morbidity and ICU stay.

Cited by 54 publications

References 14 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

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

The respiratory system in pediatric chronic heart disease

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