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Plication for diaphragm paralysis after paediatric cardiac surgery: a single-centre experience

Published online by Cambridge University Press:  06 March 2023

Baran Simsek Open the ORCID record for Baran Simsek [Opens in a new window] ,
Arda Ozyuksel Open the ORCID record for Arda Ozyuksel [Opens in a new window] ,
Murat Saygi  and
Mehmet Salih Bilal
Baran Simsek*
Affiliation:
Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
Arda Ozyuksel
Affiliation:
Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey Department of Cardiovascular Surgery, Biruni University, Istanbul, Turkey
Murat Saygi
Affiliation:
Department of Pediatric Cardiology, Medicana International Hospital, Istanbul, Turkey
Mehmet Salih Bilal
Affiliation:
Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
*
Author for correspondence: Baran Simsek, MD, Department of Cardiovascular Surgery, Medicana International Hospital, Beylikduzu Str. No: 3, Beylikduzu, Istanbul, 34520, Turkey. Tel: +90 212 8677500; Fax: +90 212 8677672. E-mail: simsekbaran7@gmail.com
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Abstract

Objective:

Diaphragm paralysis is a well-known complication following surgery for CHDs, which increases morbidity, mortality, and length of hospital stay as well as costs. Herein, we present our experience with diaphragm plication following paralysis of the phrenic nerve encountered after paediatric cardiac surgery.

Methods:

This study retrospectively reviewed the medical records of 23 diaphragm plications in 20 patients who underwent paediatric cardiac surgery between January 2012 and January 2022. The patients were carefully selected based on aetiology and a combination of clinical manifestation and chest imaging characteristics including chest X-ray, ultrasonography, and fluoroscopy.

Results:

Twenty-three successful plications were performed in 20 patients (15 males and 5 females) out of a total of 1938 operations performed in our centre. Mean age and body weight were 18.2 ± 17.1 months and 8.3 ± 3.7 kg, respectively. The period between the cardiac surgery and diaphragmatic plication was 18.7 ± 15.1 days. The highest incidence of diaphragm paralysis was encountered in systemic to pulmonary artery shunt patients with 7 out of 152 patients (4.6%). Any mortality was not encountered during a mean follow-up period of 4.3 ± 2.6 years.

Conclusions:

Early results of plication of the diaphragm following phrenic nerve palsy in symptomatic patients who underwent paediatric cardiac surgery are encouraging. Evaluation of the diaphragmatic function should be a routine part of post-operative echocardiography. Diaphragm paralysis may be a consequence of dissection, contusion, stretching, and thermal injury both in terms of hypothermia and hyperthermia.

Keywords

CHDsuniventricular heartphrenic nervediaphragmatic eventrationcardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 10 , October 2023 , pp. 2087 - 2093
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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References

Society of Thoracic Surgeons. STS Congenital Heart Surgery Database data specifications. Available at: https://www.sts.org/sites/default/files/documents/CongenitalDataSpecsV3_22.pdf. Accessed August 11, 2022.Google Scholar
Qureshi, A. Diaphragm paralysis. Semin Respir Crit Care Med 2009; 30: 315–320.10.1055/s-0029-1222445CrossRefGoogle ScholarPubMed
Stone, KS, Brown, JW, Canal, DF, King, H. Long-term fate of the diaphragm surgically plicated during infancy and early childhood. Ann Thorac Surg 1987; 44: 62–65.10.1016/S0003-4975(10)62359-4CrossRefGoogle ScholarPubMed
Zhang, YB, Wang, X, Li, SJ, Yang, KM, Sheng, XD, Yan, J. Postoperative diaphragmatic paralysis after cardiac surgery in children: incidence, diagnosis and surgical management. Chin Med J (Engl) 2013; 126: 4083–4087.Google ScholarPubMed
Guillemaud, JP, El-Hakim, H, Richards, S, Chauhan, N. Airway pathologic abnormalities in symptomatic children with congenital cardiac and vascular disease. Arch Otolaryngol Head Neck Surg 2007; 133: 672–676.10.1001/archotol.133.7.672CrossRefGoogle ScholarPubMed
Morrison, JMV. Eventration of diaphragm due to unilateral phrenic nerve paralysis. Arch Radiol Electrotherap 1923; 28: 72–75.Google Scholar
Goldberg, L, Krauthammer, A, Ashkenazi, M, et al. Predictors for plication performance following diaphragmatic paralysis in children. Pediatr Pulmonol 2020; 55: 449–454.10.1002/ppul.24539CrossRefGoogle ScholarPubMed
Shoemaker, R, Palmer, G, Brown, JW, King, H. Aggressive treatment of acquired phrenic nerve paralysis in infants and small children. Ann Thorac Surg 1981; 32: 250–259.10.1016/S0003-4975(10)61047-8CrossRefGoogle ScholarPubMed
Schwartz, MZ, Filler, RM. Plication of the diaphragm for symptomatic phrenic nerve paralysis. J Pediatr Surg 1978; 13: 259–263.10.1016/S0022-3468(78)80397-2CrossRefGoogle ScholarPubMed
Fraser, III CD, Ravekes, W, Thibault, D, et al. Diaphragm paralysis after pediatric cardiac surgery: an STS congenital heart surgery database study. Ann Thorac Surg 2021; 112: 139–146.10.1016/j.athoracsur.2020.05.175CrossRefGoogle ScholarPubMed
Tantawy, AEE, Imam, S, Shawky, H, Salah, T. Diaphragmatic nerve palsy after cardiac surgery in children in Egypt: outcome and debate in management. World J Pediatr Congenit Heart Surg 2013; 4: 19–23.10.1177/2150135112454444CrossRefGoogle ScholarPubMed
Saygılı, A, Mercan, AŞ., Bitir, N, et al. Clinical follow up of diaphragmatic paralysis in congenital heart surgery. Turkish J Thorac Cardiovasc Surg 2001; 90: 221–224.Google Scholar
Massarweh, NN, Cosgriff, N, Slakey, DP. Electrosurgery: history, principles, and current and future uses. Coll Surg 2006; 202: 520–530.10.1016/j.jamcollsurg.2005.11.017CrossRefGoogle ScholarPubMed
Henaine, R, Vergnat, M, Bacha, EA, et al. Effects of lack of pulsatility on pulmonary endothelial function in the Fontan circulation. J Thorac Cardiovasc Surg. 2013; 146: 522–529.10.1016/j.jtcvs.2012.11.031CrossRefGoogle ScholarPubMed
Gewillig, M, Brown, SC, Heying, R, et al. Volume load paradox while preparing for the Fontan: not too much for the ventricle, not too little for the lungs. Interact Cardiovasc Thorac Surg 2010; 10: 262–265.10.1510/icvts.2009.218586CrossRefGoogle Scholar
Kreutzer, C, Kreutzer, J, Kreutzer, GO. Reflections on five decades of the Fontan-Kreutzer procedure. Front Pediatr 2013; 1: 45.10.3389/fped.2013.00045CrossRefGoogle ScholarPubMed
Komori, M, Hoashi, T, Shimada, M, et al. Impact of phrenic nerve palsy on late Fontan circulation. Ann Thorac Surg 2020; 109: 1897–1902.10.1016/j.athoracsur.2019.09.064CrossRefGoogle ScholarPubMed
Ovroutski, S, Meskishvili, VA, Stiller, B, et al. Paralysis of the phrenic nerve as a risk factor for suboptimal Fontan hemodynamics. Eur J Cardiothorac Surg. 2005; 27: 561–565.10.1016/j.ejcts.2004.12.044CrossRefGoogle ScholarPubMed
Amin, Z, McElhinney, DB, Strawn, JK, et al. Hemidiaphragmatic paralysis increases postoperative morbidity after a modified Fontan operation. J Thorac Cardiovasc Surg. 2001; 122: 856–862.10.1067/mtc.2001.118506CrossRefGoogle ScholarPubMed
Hsia, TY, Khambadkone, S, Bradley, SM, de Leval, MR. Subdiaphragmatic venous hemodynamics in patients with biventricular and Fontan circulation after diaphragm plication. J Thorac Cardiovasc Surg 2007; 134: 1397–1405, discussion 1405.10.1016/j.jtcvs.2007.07.044CrossRefGoogle ScholarPubMed
Rychik, J. The relentless effects of the Fontan paradox. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2016; 19: 37–43.10.1053/j.pcsu.2015.11.006CrossRefGoogle ScholarPubMed
Stevenson, GF. Effect of unilateral diaphragm paralysis on branch pulmonary artery flow. Am Soc Echocardiogr 2002; 15: 1132–1139.10.1067/mje.2002.123256CrossRefGoogle ScholarPubMed
Podgaetz, E, Diaz, I, Andrade, RS. To sink the lifted: selection, technique, and result of laparoscopic diaphragmatic plication for paralysis or eventration. Thorac Cardiovasc Surg 2016; 64: 631–640.Google ScholarPubMed
Welvaart, WN, Jak, PMC, Veerdonk, MC, et al. Effects of diaphragm plication on pulmonary function and cardiopulmonary exercise parameters. Eur J Cardiothorac Surg 2013; 44: 643–647.10.1093/ejcts/ezt094CrossRefGoogle ScholarPubMed
Talwar, S, Agarwala, S, Mittal, CM, Choudhary, SK, Airan, B. Diaphragmatic palsy after cardiac surgical procedures in patients with congenital heart. Pediatr Cardiol 2010; 3: 50–57.10.4103/0974-2069.64370CrossRefGoogle ScholarPubMed
Ricoy, J, Rodríguez-Núñez, N, Álvarez-Dobaño, JM, Toubes, ME, Riveiro, V, Valdés, L. Diaphragmatic dysfunction. Pulmonology 2019; 25: 223–235.10.1016/j.pulmoe.2018.10.008CrossRefGoogle ScholarPubMed
Georgiev, S, Konstantinov, G, Latcheva, A, et al. Phrenic nerve injury after paediatric heart surgery: is aggressive plication of the diaphragm beneficial? Eur J Cardiothorac Surg 2013; 44: 808–812.10.1093/ejcts/ezt110CrossRefGoogle ScholarPubMed
Yemisci, OU, Cosar, SNS, Karatas, M, Aslamaci, S, Tokel, K. A prospective study of temporal course of phrenic nerve palsy in children after cardiac surgery. J Clin Neurophysiol 2011; 28: 222–226.10.1097/WNP.0b013e3182121601CrossRefGoogle ScholarPubMed
Baker, CJ, Boulom, V, Reemtsen, BL, et al. Hemidiaphragm plication after repair of congenital heart defects in children: quantitative return of diaphragm function over time. J Thorac Cardiovasc Surg 2008; 135: 56–61.10.1016/j.jtcvs.2007.09.031CrossRefGoogle ScholarPubMed
Fujishiro, J, Ishimaru, T, Sugiyama, M, et al. Thoracoscopic plication for diaphragmatic eventration after surgery for congenital heart disease in children. J Laparoendosc Adv Surg Tech A 2015; 25: 348–351.10.1089/lap.2014.0260CrossRefGoogle ScholarPubMed
Bhaskar, P, Lone, RA, Sallehuddin, A, John, J, Bhat, AN, Rahmath, MR. Bilateral diaphragmatic palsy after congenital heart surgery: management options. Cardiol Young 2016; 26: 927–930.10.1017/S1047951115001559CrossRefGoogle ScholarPubMed
Cotts, T, Hirsch, J, Thorne, M, Gajarski, R. Tracheostomy after pediatric cardiac surgery: frequency, indications, and outcomes. J Thorac Cardiovasc Surg 2011; 141: 413–418.10.1016/j.jtcvs.2010.06.027CrossRefGoogle ScholarPubMed