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Bilateral diaphragmatic palsy after congenital heart surgery: management options

Published online by Cambridge University Press:  08 September 2015

Pradeep Bhaskar ,
Reyaz A. Lone ,
Ahmad Sallehuddin ,
Jiju John ,
Akhlaque N. Bhat  and
Muhammed R. K. Rahmath Open the ORCID record for Muhammed R. K. Rahmath [Opens in a new window]
Pradeep Bhaskar*
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
Reyaz A. Lone
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
Ahmad Sallehuddin
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
Jiju John
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
Akhlaque N. Bhat
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
Muhammed R. K. Rahmath
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
*
*Correspondence to: Dr P. Bhaskar, MD, Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Hamad Medical Corporation, PO Box 3050, Doha, Qatar. Tel: +9 744 439 2995; Fax: +9 744 439 2324; E-mail: [email protected]
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Abstract

Diaphragmatic paralysis following phrenic nerve injury is a major complication following congenital cardiac surgery. In contrast to unilateral paralysis, patients with bilateral diaphragmatic paralysis present a higher risk group, require different management methods, and have poorer prognosis. We retrospectively analysed seven patients who had bilateral diaphragmatic paralysis following congenital heart surgery during the period from July, 2006 to July, 2014. Considerations were given to the time to diagnosis of diaphragm paralysis, total ventilator days, interval after plication, and lengths of ICU and hospital stays. The incidence of bilateral diaphragmatic paralysis was 0.68% with a median age of 2 months (0.6–12 months). There was one neonate and six infants with a median weight of 4 kg (3–7 kg); five patients underwent unilateral plication of the paradoxical diaphragm following recovery of the other side, whereas the remaining two patients who did not demonstrate a paradoxical movement were successfully weaned from the ventilator following recovery of function in one of the diaphragms. The median ventilation time for the whole group was 48 days (20–90 days). The median length of ICU stay was 46 days (24–110 days), and the median length of hospital stay was 50 days (30–116 days). None of the patients required tracheostomy for respiratory support and there were no mortalities, although all the patients except one developed ventilator-associated pneumonia. The outcome of different management options for bilateral diaphragmatic paralysis following surgery for CHD is discussed.

Keywords

Bilateral diaphragmatic paralysisphrenic nerve injuriesCHDcardiac surgery
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 927 - 930
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Copyright
© Cambridge University Press 2015 

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