Clinical implications of phrenic nerve injury after pediatric cardiac surgery

Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children

“…Our results with an incidence of 11.6% are similar to other series with an incidence of 2.1-19% after Blalock-Taussig shunts [3,[9][10][11]13,14,[16][17][18]. Another factor increasing the risk of DP is previous thoracic surgery.…”

“…This reduces functional residual capacity, facilitates alveolar collapse and atelectasis. Moreover, the infants recumbent position leads to a reduction of vital capacity and their small intrabronchial calibres facilitates obstruction and atelectasis by retained secretions [3,11,[13][14][15][16][17]. The highest incidence of DP after open-heart surgery was seen after Fontan operation.…”

“…A reason may be that arterial switch operations often require harvesting of autologous pericardium and/or thymus resection [3,[9][10][11]13,14,16,18]. All cardiac surgery on bypass were done in mild to moderate hypothermia depending from complexity and duration of surgery.…”

“…In contrast to infants and younger children, older children can compensate the loss of diaphragmatic function and usually present with little or no symptoms [3,[11][12][13][14][15][16][17].…”

Laparoscopic diaphragmatic plication: long-term results of a novel surgical technique for postoperative phrenic nerve palsy

“…This is even more difficult since the natural history of PNP following cardiac surgery is not known and spontaneous recovery of the affected diaphragm has been reported in as many as 78% of patients [3,5]. A number of institutions perform diaphragmatic plication after iatrogenic phrenic nerve palsy in as many as 44% of all affected patients [4,20]. As done in patient 2, most centers consider surgery at 30 days after ineffective conservative therapy of PNP [18].…”