Hemidiaphragm plication after repair of congenital heart defects in children: Quantitative return of diaphragm function over time

Objective Phrenic nerve injury resulting in hemidiaphragm paresis leads to morbidity in children undergoing repair of congenital heart defects. Previous studies have documented short-term benefits of diaphragm plication, but little is known about the return of diaphragm function. Methods We reviewed...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2008, Vol.135 (1), p.56-61
Main Authors: Baker, Craig J., MD, Boulom, Valy, MS, Reemtsen, Brian L., MD, Rollins, Robert C., MD, Starnes, Vaughn A., MD, Wells, Winfield J., MD
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiac Surgical Procedures - adverse effects
Cardiology. Vascular system
Cardiothoracic Surgery
Child
Child, Preschool
Diaphragm - physiopathology
Female
Heart Defects, Congenital - surgery
Humans
Infant
Male
Medical sciences
Phrenic Nerve - injuries
Pneumology
Recovery of Function
Respiratory Paralysis - etiology
Respiratory Paralysis - surgery
Retrospective Studies
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objective Phrenic nerve injury resulting in hemidiaphragm paresis leads to morbidity in children undergoing repair of congenital heart defects. Previous studies have documented short-term benefits of diaphragm plication, but little is known about the return of diaphragm function. Methods We reviewed 46 consecutive patients undergoing hemidiaphragm plication after repair of congenital heart defects. The function of plicated diaphragms was measured at follow-up fluoroscopy using excursion of the unplicated side as a control. Results The median age at the procedure resulting in phrenic nerve injury was 6.4 months (0–62 months). Among the 46 patients, 29 (63%) and 17 (37%) had repair for single and 2-ventricle defects, respectively. Hemidiaphragm paresis occurred on the left side in 32 patients (70%). Phrenic nerve injury was documented at a median of 8 days (1–84 days) after operation. The median time from diagnosis to plication was 2 days (0–21 days). Five patients required prolonged ventilation after plication. One patient died 10 weeks later, and 4 patients required tracheostomy. The remaining 41 patients were extubated within 2 days (0–19 days). In 17 patients, fluoroscopy assessing diaphragm motion was performed at a mean interval of 16.4 months after plication. Excursion of the plicated diaphragm was 77% of the contralateral side. There was a trend toward improved function over time. Conclusions Hemidiaphragm paresis results in significant morbidity after repair of congenital heart defects. Early diagnosis and plication result in timely extubation. The plicated diaphragm demonstrates return of function that may improve over time. This is the first study to numerically quantitate the degree of diaphragm recovery.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2007.09.031