Diaphragmatic Dysfunction Following Endoscopic Coronary Artery Bypass Grafting in a Patient With Concomitant Sleep Disordered Breathing: A Case Report

Abstract

Unilateral diaphragmatic paralysis (UDP) is a frequent complication following cardiac surgery, usually affecting the left hemidiaphragm. Here, we present a case of a right-sided UDP following endoscopic coronary artery bypass grafting (CABG), which is far more uncommon. A 60-year-old male patient presented at our outpatient clinic with exertional dyspnoea and orthopnoea. Breathing sounds were diminished upon auscultation of the right lung base. He recently underwent a CABG through video-assisted thoracoscopic surgery (VATS). We documented a new right-sided UDP as well as severe obstructive sleep apnoea syndrome (OSAS) in this patient. We started inspiratory muscle training for the diaphragm palsy as well as continuous positive airway pressure (CPAP) therapy to ameliorate his OSAS since this is negatively influenced by UDP. The combination of this particular surgical method, the concomitant OSAS, and the right side of the UDP make this a unique case. In this report, we will briefly summarize several aspects of diaphragmatic dysfunction in the post-CABG setting, with a thorough focus on the role of ultrasound in its diagnosis and follow-up.