Management of diaphragmatic paralysis in infants with special emphasis on selection of patients for operative plication

Haller, Julia A.; Pickard, Laurens R.; Tepas, Joseph J.; Rogers, Mark C.; Robotham, James L.; Shorter, Nicholas A.; Shermeta, Dennis W.

doi:10.1016/s0022-3468(79)80264-x

Cited by 66 publications

(35 citation statements)

References 6 publications

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“…Respiratory condition is one of the most important factors influencing mortality and morbidity especially in infants. DP after cardiac surgery is an important complication with negative effects on pulmonary situation [1][2][3][4][5][6][7][8][9]. Reports of the prevalence of DP after cardiac operations in children vary from 0.3 to 12.8% [3, 6, 10-12, 16, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Diaphragmatic paralysis (DP) due to phrenic nerve injury after congenital cardiac surgery is an important respiratory complication resulting with respiratory insufficiency, lung infections, prolonged hospital stay time and even death [1][2][3][4][5][6][7][8][9]. It is accepted that procedures in congenital cardiac surgery are the major causes of DP with an incidence ranging from 0.3 to 12.8% [2,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…The common feature of DP after cardiac surgery in children is inability in weaning from mechanical ventilation or requirement of reintubation. This situation is the major cause of lung infections and related complications such as atelectasis and recurrent pneumonia [3][4][5]. Great majority of older children have the advantage of overcoming DP as they use their intercostal muscles for respiration when compared with infants [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management

et al. 2006

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Diaphragmatic paralysis (DP) after cardiac surgery is an important complication especially in infants. We analyzed the incidence, clinical course, surgical management and follow up of the patients with DP, retrospectively. Between 1996 and 2005, 3,071 patients underwent cardiac surgery. Total number of patients with DP was 152 (4.9%). Out of 152 patients, 42 were surgically treated with transthoracic diaphragm plication (1.3%). The overall incidence of diaphragm paralysis was higher in correction of tetralogy of Fallot (31.5%), Blaloc-Taussig (B-T) shunt (11.1%) and VSD closure with pulmonary artery patch plasty (11.1). The incidence of DP which require plication was higher in B-T shunt (23.8%) arterial switch (19%) and correction of tetralogy of Fallot (11.9%). Mean and median age at the time of surgery were 17.8 +/- 3.6 and 6 months, respectively. Median time from cardiac surgery to surgical plication was 12 days. Indications for plication were repeated reintubations (n = 22), failure to wean from ventilator (n = 12), recurrent lung infections (n = 5) and persistent respiratory distress (n = 3). Mortality rate was 19.1%. Being under 1 year of age, pneumonia and plication 10 days after mechanical ventilation were associated with higher incidence mortality (P < 0.05). Phrenic nerve injury is a serious complication of cardiac surgery. It is more common after some special procedures. Spontaneous recovery is very rare. Being under 1 year of age, plication after 10 days from the surgery and pneumonia are major risk factors for mortality even in plicated patients. Transthoracic plication is helpful if performed early.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management

et al. 2006

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“…If most nerves were viable, then contractions were vigorous. Currently, fluoroscopy i s u s e d t o d e t e c t diaphragmatic function [34]. It is important to assess the diaphragmatic movement under fluoroscopy, as there have been misdiagnoses in detecting diaphragmatic contractions without it [35].…”

Section: Viability Of Phrenic Nervementioning

confidence: 99%

Diaphragmatic Pacemaker

Surani¹

2011

Modern Pacemakers - Present and Future

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“…There is a report where a total eventration of the hemidiaphragm with acute respiratory distress was treated with emergency plication [1]. Respiratory improvement after application of continuous positive airway pressure may identify patients who respond well to surgical plication because both interventions stabilize the diaphragm and increase the functional residual capacity [5].…”

mentioning

confidence: 99%