Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children
| Autor: | Ana L. Joho-Arreola, Vera Bernet, Stauffer Ug, Oskar Baenziger, Urs Bauersfeld |
|---|---|
| Přispěvatelé: | University of Zurich |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Time Factors Heart Diseases medicine.medical_treatment Diaphragmatic breathing 610 Medicine & health Diaphragmatic paralysis 142-005 142-005 2705 Cardiology and Cardiovascular Medicine Fontan procedure Humans Medicine Cardiac Surgical Procedures Retrospective Studies Phrenic nerve Respiratory distress Plicatura biology business.industry Infant Newborn Infant General Medicine Thoracic Surgical Procedures biology.organism_classification Respiration Artificial Respiratory Paralysis 2746 Surgery Surgery Cardiac surgery Phrenic Nerve Treatment Outcome 2740 Pulmonary and Respiratory Medicine Cardiothoracic surgery Child Preschool Anesthesia Cardiology and Cardiovascular Medicine business Algorithms |
| Popis: | Objective: Diaphragmatic paralysis (DP) caused by phrenic nerve injury is potentially life-threatening in infants. Phrenic nerve injury due to thoracic surgery is the most common cause of DP in children. We retrospectively analyzed incidence, surgical details, management and followup of our patients with DP after cardiac surgery to develop an algorithm for the management and follow-up. Methods: Retrospective analysis of 43 patients with DP after cardiac surgery performed between 1996 and 2000. Results: Median age at cardiac surgery was 1 month (range 3 days to 9 years). Incidence of DP was 5.4%. A trend towards higher incidences of DP were observed after arterial switch operation (10.8%, PZ0.18), Fontan procedure (17.6%, PZ0.056) and Blalock–Taussig Shunt (12.8%, PZ0.10). Median time from cardiac surgery to surgical plication was 21 days (range 7–210 days). Transthoracic diaphragmatic plication was performed in 29/43 patients, no plication was done in 14/43 patients. Patients in whom diaphragmatic plication was required were younger (median age 2 months, range 21 days to 53 months versus 17.5 months, range 4 days to 110 months; P!0.001). Indications for plication were failure to wean from ventilator (nZ22), respiratory distress (nZ4), cavopulmonary anastomosis (nZ2), and failure to thrive (nZ1). All these symptoms resolved after diaphragmatic plication, however, 8/29 patients with plication and 2/14 without plication died. Cause of death was not related to diaphragmatic plication in any patient. Position of plicated diaphragm was normal in 18/21 surviving patients 1 month after plication. In 2/12 surviving patients without plication hemidiaphragm showed a normal position 1 year after surgery. The rate of pulmonary infections was not significantly different during 12–60 months follow-up. Conclusions: DP is an occasional complication of cardiac surgery. High incidences of DP were seen after arterial switch operation, Fontan procedure and Blalock–Taussig shunt (BT). Respiratory insufficiency requires diaphragmatic plication in most infants with DP whereas older children may tolerate DP. Transthoracic diaphragmatic plication is an effective treatment of DP and achieves relief of respiratory insufficiency in most patients. Spontaneous recovery from postsurgical DP is rare. q 2004 Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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