COMBINED LEFT-SIDED RECURRENT LARYNGEAL AND PHRENIC-NERVE PALSY AFTERCORONARY-ARTERY OPERATION

Background. Ice/saline slush used along with cold cardioplegia for hea rt arrest in cardiac operations can cause hypothermic damage to certai n structures, an important one being the left phrenic nerve, damage of which results in raised left hemidiaphragm and delayed recovery of th e patient. In coronary artery bypass grafting, opening of the pleura a nd collection of the ice/saline slush in the pleural cavity increases the incidence of injury. Methods. Three of our nonconsecutive patients underwent coronary artery bypass grafting with cold cardioplegia and open pleura, with collection of ice/saline slush in the pleural cavity for a sufficiently long time. Results. Simultaneous involvement of le ft recurrent laryngeal nerve along with left phrenic nerve was found i n all patients without any concurrent topical injury around the larynx . The recurrent laryngeal nerve took 8 to 10 months to recover. Conclu sions. The left recurrent nerve as it arches around aorta lies in the thorax very close to the parietal pleura and may be prone to hypotherm ic injury by ice/slush collecting in the pleural cavity during cardiac operations. Judicious use of ice/saline slush has helped in eliminati ng the problem to some extent.