Phrenic nerve injury associated with high free right internal mammary artery harvesting

Deng, Yongzhi; Byth, Karen; Paterson, Hugh S.

doi:10.1016/s0003-4975(03)00511-3

Cited by 48 publications

(39 citation statements)

References 17 publications

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“…In particular, coronary artery bypass grafting (CABG) surgery is frequently associated with lesions of the phrenic nerves resulting in post-operative diaphragmatic paralysis, with incidences reported as varying from 1% to 60% [7,8,9,10,11]. One of the reasons for this wide estimate probably lies in the various surgical techniques used during CABG: harvesting of the internal mammary artery (IMA) and the use of topical ice slush for cardiac cooling are associated with an increased risk of phrenic injury [7,9,10,11,12,13,14], the former because of the close anatomical relationship of the nerve and the IMA and the latter because of the traumatic demyelinating injury to the phrenic nerved induced by the cold temperature. …”

Section: Etiology Of Diaphragmatic Dysfunctionmentioning

confidence: 99%

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé

Dres

2016

JCM

155

109

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The diaphragm is the main inspiratory muscle, and its dysfunction can lead to significant adverse clinical consequences. The aim of this review is to provide clinicians with an overview of the main causes of uni- and bi-lateral diaphragm dysfunction, explore the clinical and physiological consequences of the disease on lung function, exercise physiology and sleep and review the available diagnostic tools used in the evaluation of diaphragm function. A particular emphasis is placed on the clinical significance of diaphragm weakness in the intensive care unit setting and the use of ultrasound to evaluate diaphragmatic action.

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Section: Etiology Of Diaphragmatic Dysfunctionmentioning

confidence: 99%

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé

Dres

2016

JCM

155

109

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“…Peripheral nerve growth rates have been shown to differ in the proximal and distal segments of a peripheral nerve ranging from 1 to 8 mm per day [18] . Assuming that the injury occurs at the level of the first rib during high mobilizing RIMA, the length of phrenic nerve to its entry of the diaphragmatic crux was estimated at 300 mm (as the average length of RIMA was about 180 to 200 mm and that from the IMA bifurcation to diaphragmatic crux was about 80 to 120 mm), the recovery time will be 38 to 300 days [19] . These findings are consistent with the reported recovery rate of diaphragmatic dysfunction after PNI ranging from 1 to 18 months [7,20] , but obviously are only a rough estimation, as accurate regeneration rates have not been established for phrenic nerve.…”

Section: Recovery Of Phrenic Nerve Injurymentioning

confidence: 99%

Semi-skeletonized internal mammary grafts and phrenic nerve injury: Cause-and-effect analysis

Deng

Sun

et al. 2006

J. Huazhong Univ. Sc. Technol.

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Phrenic nerve injury after cardiac surgery increases postoperative pulmonary complications. The purpose of this study was to analyze the causes and effects of phrenic nerve injury after cardiac surgery. Prospectively collected data on 2084 consecutive patients who underwent cardiac surgery from Jan. 1995 to Feb. 2002 were analyzed. Twenty-eight preoperative and operation related variables were subjected to logistic analysis with the end point being phrenic nerve injury. Then phrenic nerve injury and 6 perioperative morbidities were included in the analysis as variables to determine their independent predictive value for perioperative pulmonary morbidity. An identical approach was used to identify the independent risk factors for perioperative mortality. There were 53 phrenic nerve injuries (2.5%). There was no phrenic nerve injury in non-coronary surgery or coronary surgery using conduits other than the internal mammary artery. The independent risk factors for phrenic nerve injury were the use of internal mammary artery (Odds ratio (OR) = 14.5) and thepresence of chronic obstructive pulmonary disease (OR = 2.9). Phrenic nerve injury was an independent risk factor (OR = 8.1) for perioperative pulmonary morbidities but not for perioperative mortality. Use of semi-skeletonized internal mammary artery harvesting technique and drawing attention to possible vascular or mechanical causes of phrenic nerve injury may reduce its occurrence. Unilateral phrenic nerve injury, although rarely life-threatening, is an independent risk factor for postoperative respiratory complications. When harvesting internal mammary arteries, it should be kept in mind avoiding stretching, compromising, or inadvertently dissecting phrenic nerve is as important as avoiding damage of internal mammary artery itself.

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“…Furthermore, it is generally acknowledged that the nerve carries its accompanying arteries and veins throughout its course in the thoracic cavity. As indicated by the relevant literature, some attention has been paid to the anatomy of the phrenic nerve in the thoracic cavity, but the focus has been mainly on its anatomical protection (Tripp and Bolton 1998;Deng et al 2003). Therefore, it is imperative that the precise course of the phrenic nerve, and close correlation with its adjacent tissues and organs be fully appreciated to assist surgeries aimed at dissecting the whole nerve together its accompanying vessels, especially for endoscopic manipulations, as a transition from endoscopic to open thoracic surgery is, to some extent, often considered as a failure.…”

Section: Introductionmentioning

confidence: 99%

“…The above discussion notwithstanding, there have been some anatomic studies on thoracic phrenic nerve and its precise relation with adjacent anatomical structures (Fell 1998;Tripp and Bolton 1998;Deng et al 2003). However, there is currently insufficient appreciation of the morphological features of the nerve in terms of descending trajectory, blood supply and anatomical relationships.…”

Section: Introductionmentioning

confidence: 99%

An anatomical study of the full-length phrenic nerve and its blood supply: clinical implications for endoscopic dissection

Shen

et al. 2011

Anat Sci Int

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For surgeries aimed at the dissection of full-length phrenic nerve, a full appreciation of its trajectory, blood supply and correlation with adjacent anatomical structures is necessary, especially for endoscopic manipulations. A fresh cadaver study was conducted with the purpose of avoiding surgical complications and ensuring further efficacy and efficiency of endoscopic manipulations. Ten fresh adult cadavers were dissected. Special attention was paid to the topography of the origin, the trajectory of the phrenic nerve, and its anatomic communication with the surrounding vessels and organs. In the second side of the cadavers, thoracic endoscopic manipulations and observations were also performed. The full length of the phrenic nerve was 24.6 ± 1.7 and 30.6 ± 1.8 cm on the right and left side, respectively; the blood supply of the phrenic nerve in the thoracic cavity came exclusively from the pericardiacophrenic artery; the distance between the origin of the pericardiacophrenic artery and that of the internal thoracic artery ranged from 0.5 to 5.2 cm on the right side, and from 1.4 to 5.6 cm on the left; most of the pericardiacophrenic veins intermingled with small vessels of pericardium and pleura, forming a venous network and joining the innominate vein. Endoscopic dissection of the thoracic phrenic nerve together with the accompanying pericardiacophrenic artery can be performed. Extreme attention should be paid during surgery to a section of about 6 cm in length of the artery originating from the internal thoracic artery, while the accompanying veins do not require to be spared.

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Phrenic nerve injury associated with high free right internal mammary artery harvesting

Cited by 48 publications

References 17 publications

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Semi-skeletonized internal mammary grafts and phrenic nerve injury: Cause-and-effect analysis

An anatomical study of the full-length phrenic nerve and its blood supply: clinical implications for endoscopic dissection

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