PHRENIC-NERVE DAMAGE VIA A RIGHT THORACOTOMY IN OLDER CHILDREN WITH SECUNDUM ASD

Phrenic nerve damage (PND) in children after cardiac operations is now recognized as being more frequent than previously thought. In a prosp ective study on 400 children, we previously demonstrated electrophysio logic evidence of postoperative PND in approximately 16% of patients, with one third of cases occurring in children under 18 months. In the past 18 months, 30 children have had atrial septal defect (ASD) repair s as their only operative procedure. Fourteen children had ASD repairs via a midline incision, and 16 ASD repairs were via a right thoracoto my. No PND (assessed by phrenic nerve latency) was found after a midli ne approach. In the right thoracotomy group, 5 children had evidence o f PND (31%; p = 0.05). Four of these 5 patients were female and more t han 14 years of age. The incidence of damage in this pubescent group w as 80% (p < 0.05). In the older age group the duration of ventilation was not prolonged, but affected patients had symptoms of fatigue and b reathlessness postoperatively. These data suggest a strong association between right thoracotomies for ASD repairs and PND, especially in th e female pubescent group when a low submammary skin incision (seventh to eighth space) is used with a fifth to sixth space entry into the th oracic cavity. In conclusion, the right thoracotomy approach for ASD r epair appears to be a significant risk factor for PND in older childre n.