In-situ left-sided bilateral internal thoracic artery: elevated hemidiaphragm
| Autor: | Dan Abrahamov, Menachem Matsa, Mahmud Abu Salah, Yael Refaely, Nina Baram, Gideon Sahar, Yaron Ishai, Oren Lev-Ran, Ohad Gabai |
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| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male Diaphragm Internal thoracic artery 030204 cardiovascular system & hematology Left sided Respiratory paralysis Phrenic Nerve Injury 03 medical and health sciences 0302 clinical medicine Peripheral Nerve Injuries Risk Factors medicine.artery medicine Humans Thoracic artery Israel Mammary Arteries Internal Mammary-Coronary Artery Anastomosis Phrenic nerve Aged Retrospective Studies business.industry Incidence General Medicine Anatomy ELEVATED HEMIDIAPHRAGM Middle Aged musculoskeletal system Respiratory Paralysis Diaphragm (structural system) Phrenic Nerve Treatment Outcome 030228 respiratory system Surgery Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Asian cardiovascularthoracic annals. 26(2) |
| ISSN: | 1816-5370 |
| Popis: | Background Procurement of the internal thoracic artery risks ipsilateral phrenic nerve injury and elevated hemidiaphragm. Anatomical variations increase the risk on the right side. Patients receiving left-sided in-situ right internal thoracic artery configurations appear to be at greatest risk. Methods From 2014 to 2016, 432 patients undergoing left-sided in-situ bilateral internal thoracic artery grafting were grouped according to right internal thoracic artery configuration: retroaortic via transverse sinus (77%) or ante-aortic (23%); targets were the circumflex and left anterior descending artery territories, respectively. Elevated hemidiaphragm was assessed by serial chest radiographs and categorized by side, complete (≥2 intercostal spaces) versus partial, and permanent versus transient. Results Right elevated hemidiaphragm occurred in 4.2% of patients. The incidence of radiological complete right elevated hemidiaphragm was 2.8% (12/432); 8 cases were transient with recovery in 3.5 ± 0.3 weeks. Permanent right elevated hemidiaphragm occurred in 0.9% (retroaortic group only). Permanent left elevated hemidiaphragm occurred in 0.9% and was significantly higher in the ante-aortic group (3/99 vs. 1/333, p = 0.039). No bilateral hemidiaphragm elevation was documented. Partial right elevated hemidiaphragm occurred in 1.4% and was not associated with adverse early or late respiratory outcomes. Conclusions Despite susceptible right phrenic nerve-internal thoracic artery anatomy, the incidence of permanent right elevated hemidiaphragm is low and no higher than left-sided in prone bilateral internal thoracic artery subsets. This reflects skeletonized internal thoracic artery procurement. Although statistical significance was not achieved, a retroaortic right internal thoracic artery configuration may constitute a higher risk of right phrenic nerve injury. |
| Databáze: | OpenAIRE |
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