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Bilateral diaphragmatic palsy after congenital heart surgery: management options

Published online by Cambridge University Press:  08 September 2015

Pradeep Bhaskar ,
Reyaz A. Lone ,
Ahmad Sallehuddin ,
Jiju John ,
Akhlaque N. Bhat  and
Muhammed R. K. Rahmath Open the ORCID record for Muhammed R. K. Rahmath [Opens in a new window]
Pradeep Bhaskar*
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
Reyaz A. Lone
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
Ahmad Sallehuddin
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
Jiju John
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
Akhlaque N. Bhat
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
Muhammed R. K. Rahmath
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
*
*Correspondence to: Dr P. Bhaskar, MD, Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, PO Box 3050, Doha, Qatar. Tel: +9 744 439 2995; Fax: +9 744 439 2324; E-mail: pbhaskar@hamad.qa
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Abstract

Diaphragmatic paralysis following phrenic nerve injury is a major complication following congenital cardiac surgery. In contrast to unilateral paralysis, patients with bilateral diaphragmatic paralysis present a higher risk group, require different management methods, and have poorer prognosis. We retrospectively analysed seven patients who had bilateral diaphragmatic paralysis following congenital heart surgery during the period from July, 2006 to July, 2014. Considerations were given to the time to diagnosis of diaphragm paralysis, total ventilator days, interval after plication, and lengths of ICU and hospital stays. The incidence of bilateral diaphragmatic paralysis was 0.68% with a median age of 2 months (0.6–12 months). There was one neonate and six infants with a median weight of 4 kg (3–7 kg); five patients underwent unilateral plication of the paradoxical diaphragm following recovery of the other side, whereas the remaining two patients who did not demonstrate a paradoxical movement were successfully weaned from the ventilator following recovery of function in one of the diaphragms. The median ventilation time for the whole group was 48 days (20–90 days). The median length of ICU stay was 46 days (24–110 days), and the median length of hospital stay was 50 days (30–116 days). None of the patients required tracheostomy for respiratory support and there were no mortalities, although all the patients except one developed ventilator-associated pneumonia. The outcome of different management options for bilateral diaphragmatic paralysis following surgery for CHD is discussed.

Keywords

Bilateral diaphragmatic paralysisphrenic nerve injuriesCHDcardiac surgery
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 927 - 930
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Copyright
© Cambridge University Press 2015 

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References

1. Qureshi, A. Diaphragm paralysis. Semin Respir Crit Care Med 2009; 30: 315–320.CrossRefGoogle ScholarPubMed
2. de Leeuw, M, Williams, JM, Freedom, RM, Williams, WG, Shemie, SD, McCrindle, BW. Impact of diaphragmatic paralysis after cardiothoracic surgery in children. J Thorac Cardiovasc Surg 1999; 118: 510–517.Google Scholar
3. Georgiev, S, Konstantinov, G, Latcheva, A, Mitev, P, Mitev, I, Lazarov, S. Phrenic nerve injury after paediatric heart surgery: is aggressive plication of the diaphragm beneficial? Eur J Cardiothorac Surg 2013; 44: 808–812.Google Scholar
4. Stewart, S, Alexson, C, Manning, J. Bilateral phrenic nerve paralysis after the Mustard procedure. Experience with four cases and recommendations for management. J Thorac Cardiovasc Surg 1986; 92: 138–141.CrossRefGoogle ScholarPubMed
5. Dagan, O, Nimri, R, Katz, Y, Birk, E, Vidne, B. Bilateral diaphragm paralysis following cardiac surgery in children: 10-years’ experience. Intensive Care Med 2006; 32: 1222–1226.Google Scholar
6. Joho-Arreola, AL, Bauersfeld, U, Stauffer, UG, Baenziger, O, Bernet, V. Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children. Eur J Cardiothorac Surg 2005; 27: 53–57.Google Scholar
7. Coisel, Y, Chanques, G, Jung, B, et al. Neurally adjusted ventilatory assist in critically ill postoperative patients: a crossover randomized study. Anesthesiology 2010; 113: 925–935.Google Scholar
8. Miller, SG, Brook, MM, Tacy, TA. Reliability of two-dimensional echocardiography in the assessment of clinically significant abnormal hemidiaphragm motion in pediatric cardiothoracic patients: comparison with fluoroscopy. Pediatr Crit Care Med 2006; 7: 441–444.Google Scholar
9. Sanchez de Toledo, J, Munoz, R, Landsittel, D, et al. Diagnosis of abnormal diaphragm motion after cardiothoracic surgery: ultrasound performed by a cardiac intensivist vs. fluoroscopy. Congenit Heart Dis 2010; 5: 565–572.Google Scholar
10. Mickell, JJ, Oh, KS, Siewers, RD, Galvis, AG, Fricker, FJ, Mathews, RA. Clinical implications of postoperative unilateral phrenic nerve paralysis. J Thorac Cardiovasc Surg 1978; 76: 297–304.Google Scholar
11. Srivastava, V, Pasha, T, Knowles, A, et al. Dramatic improvement after bilateral diaphragmatic plication in Charcot-Marie-Tooth disease. Ann Thorac Surg 2014; 97: 2177–2179.Google Scholar
12. Stolk, J, Versteegh, MI. Long-term effect of bilateral plication of the diaphragm. Chest 2000; 117: 786–789.Google Scholar
13. Baker, CJ, Boulom, V, Reemtsen, BL, Rollins, RC, Starnes, VA, Wells, WJ. Hemidiaphragm plication after repair of congenital heart defects in children: quantitative return of diaphragm function over time. J Thorac Cardiovasc Surg 2008; 135: 56–61.Google Scholar
14. Cotts, T, Hirsch, J, Thorne, M, Gajarski, R. Tracheostomy after pediatric cardiac surgery: frequency, indications, and outcomes. J Thorac Cardiovasc Surg 2011; 141: 413–418.Google Scholar
15. Akay, TH, Ozkan, S, Gultekin, B, et al. Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management. Pediatr Surg Int 2006; 22: 341–346.Google Scholar
16. Kovacikova, L, Dobos, D, Zahorec, M. Non-invasive positive pressure ventilation for bilateral diaphragm paralysis after pediatric cardiac surgery. Interact Cardiovasc Thorac Surg 2009; 8: 171–172.Google Scholar