Phrenic nerve injury is a rare complication after open-heart surgery in the pediatric population. The injury is more prevalent after repeat open-heart procedures. We evaluate our data on phrenic nerve injury and the role of diaphragmatic plication in infants.
Charts of 450 infants who underwent open-heart surgery were reviewed. Of these, 56 were undergoing repeat open-heart surgery. Eight infants had phrenic nerve paralysis after open-heart surgery. Except for two infants, all were dependent on the ventilator and had failed extubation. All had unilateral paralysis of the diaphragm. Phrenic nerve paralysis was initially detected on chest x-ray and confirmed by fluoroscopy and/or ultrasound. The two infants not on the ventilator had symptoms of fatigue and dyspnea on exertion. Lung function was subjectively evaluated as the ability to come off the ventilator. After failing weaning off the ventilator twice in 2 weeks, the infants underwent diaphragm plication
After diaphragmatic plication, there was no operative mortality. All children were weaned off the ventilator within 4-7 days. There have been no late deaths. Four of the eight children over a period of 4 years have recovered phrenic nerve action as assessed by ultrasound. The two symptomatic infants who did not undergo diaphragmatic plication after phrenic nerve paralysis significantly improved with no more dyspnea.
Diaphragmatic plication may be required in mechanically ventilated infants with prior phrenic nerve injury. It offers a significant benefit to infants with diaphragmatic paralysis and should be done earlier in order to facilitate weaning from mechanical ventilation.CLINICAL IMPLICATION: Infants requiring mechanical ventilation following phrenic nerve injury may require diaphragmatic plication, whereas extubated infants can be managed conservatively.
S. Bhimji, None.