Title: Diaphragmatic Paralysis Following Congenital Cardiac Surgery-A Single Center Experience
Authors: Dr Reyaz Ahmad Lone, Dr Pradeep Bhaskar, Dr Akhlaque Nabi Bhat, Dr Jiju John,: Dr Muhammed Riyas K Rahmath, Dr Aslam Faris, Dr Pawel A Tysarowski, Dr Ahmed Elesawy, Dr Shadab Nabi Wani, Dr Faraz Masud, Dr Ahmad Bin Sallehuddin
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.131
Abstract
Objective - To study the prevalence and clinical effects of diaphragmatic paralysis following congenital cardiac surgery and to analyse the impact of an aggressive plication strategy in symptomatic patients.
Type of Study-Retrospective chart review
Methods- 27 children who were subjected to either closed or open heart surgery for congenital heart disease and underwent diaphragmatic plication or required prolonged ventilator support for DP post operatively during eight consecutive years from Jan 2006 till Dec 2013 were identified. Medical records of all these patients were retrospectively reviewed for demographics, primary cardiac diagnosis, details of operation, details of diaphragm palsy and management, ventilation days, length of intensive care unit and hospital stay. Any other information which was thought to be relevant was also noted and all data were statistically analysed.
Results- The incidence of clinically significant diaphragmatic palsy was 3% with 0.67% frequency of bilateral phrenic nerve palsy. The affected children had a median age of 0.9 months (0.2- 56.9) with a median weight of 3.6kg (2.7-13). 85% of patients were under 1 year with 48% neonates. The median time to diagnosis of DP after primary surgery was 6 days (1-35). Plication was done at a median interval of 7 days (1-38) in unilateral DP patients compared to 30.5 days (21-89) in case of bilateral DP. Following plication the patients were extubated at a median interval of 1day (0-60). The median total ventialtory time (48 v/s 8 days), ICU and hospital length of stay (53.5 v/s 16 and 57 v/s 23 days respectively ) were significantly prolonged in case of children with bilateral DP as compared to unilateral DP.
Conclusion- Diaphragmatic paralysis following pediatric cardiac surgery continue to be a major cause of morbidity and prolonged hospital stay. Younger children especially infants and single ventricle patients are more affected clinically requiring surgical intervention. An aggressive plication strategy in these subgroup of patients are safe and can promote a faster recovery and shorter hospital stay avoiding complications related to prolonged ventilation.
