CLINICAL IMPLICATIONS OF PHRENIC-NERVE INJURY AFTER PEDIATRIC CARDIAC-SURGERY

Phrenic nerve injury with resulting diaphragm paralysis occurred in 25 (1.5%) of 1,656 cardiac surgical procedures in children during a 10-y ear period. Phrenic nerve injury was most commonly noted in patients w ho had undergone previous cardiac surgery (16 of 165, 10%; P < .0001), typically after a previous Blalock-Taussig shunt (10 of 53, 19%: P = .007). Plication of the diaphragm (7 thoracic, 4 abdominal) was perfor med in 11 patients (44%). Indications for plication were inability to wean from mechanical ventilation (5 patients) and persistent or recurr ent respiratory distress (6 patients). The patients who needed diaphra gm plication were significantly younger than those who were managed co nservatively (median, 11 months [4 days to 23 months] versus 20 months [4 months to 16 years]: P = .01). All patients older than 2 years wer e extubated within 3 days (mean, 1.5 days) and did not need any surgic al intervention. The median follow-up period was 3.2 years, and no pat ient has had recurrent respiratory problems. There were no deaths as a direct result of phrenic nerve injury. Phrenic nerve injury after car diac surgery is a serious complication that often leads to respiratory insufficiency in patients under than 2 years of age. For such patient s, early diaphragm plication is a simple and effective procedure that prevents the complications of prolonged mechanical ventilation. Copyri ght (C) 1996 by W.B. Saunders Company