Surgical Treatment of Diaphragmatic Paralysis in Infants with Congenital Heart Disease after Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DINGNan ¹ , SHUQiang ² ,  LIXiao-feng ¹ , GUOJian ¹ , BAISong ¹ , SONGZhen-jiang ¹ , SHENLei ¹ , ZHENGJia ¹ , YANGYang ¹

1. Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, Beijing 100045, P. R. China;
2. The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, P. R. China;

Corresponding?author：

LIXiao-feng, Email: xiaofengl2000@sina.com

Keywords：

Congenital heart disease; Diaphragmatic paralysis; Diaphragmatic plication

DOI：

10.7507/1007-4848.20160190

Video：

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Objective To investigate the clinical manifestations, diagnosis and treatment of diaphrammatic paralysis (DP) in infants with congenital heart disease (CHD) after cardiac surgery. Methods Between October 2008 and June 2014, among 2 962 infant patients ( < 1 year) underwent cardiac surgery for congenital heart disease, postoperative DP was diagnosed in 31 patients. The paralysed hemidiaphragm was left side in 10 patients, right side in 15 patients, and bilateral in 6 patients. There were 22 males and 9 females. The age at operation was 1-12 (4.5±4.2) months on the average. The body weight at operation was 2.9 to 8.5 (5.6±2.2) kg on the average.All children received mechanical ventilation. Results No patient died in this study.There was a statistical difference between preoperative and postoperative mechanical ventilation time at 123-832 (420±223) hours versus 15-212 (75±58) hours (P < 0.05). Conclusions DP caused by phrenic nerve injury during surgical intervention for congenital heart disease is an important risk factor in terms of morbidity during the postoperative period. Diaphragmatic plication appears a good option, especially in infant children, to wean patients from mechanical ventilation and to prevent long-term side effects of mechanical ventilation.

Citation： DINGNan, SHUQiang, LIXiao-feng, GUOJian, BAISong, SONGZhen-jiang, SHENLei, ZHENGJia, YANGYang. Surgical Treatment of Diaphragmatic Paralysis in Infants with Congenital Heart Disease after Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(8): 792-795. doi: 10.7507/1007-4848.20160190 Copy

1.	?Guillemaud JP, El-Hakim H, Richards S, et al. Airway pathologic abnormalities in symptomatic children with congenital cardiac and vascular disease. Arch Otolaryngol Head Neck Surg, 2007, 133 (7):672-676.
2.	Lemmer J, Stiller B, Heise G, et al. Postoperative phrenic nerve palsy:early clinical implications and management. Intensive Care Med, 2006, 32(8):1227-1233.
3.	De Leeuw M, Williams JM, Freedom RM, et al. Impact of diaphrag-matic paralysis after cardiothoracic surgery in children. J Thorac Cardiovasc Surg, 1999, 118(3):510-517.
4.	Jog SM, Patole SK. Diaphragmatic paralysis in extremely low birth-weight neonates:Is waiting for spontaneous recovery justified? J Paediatr Child Health, 2002, 38(1):101-103.
5.	El Tantawy AE, Imam S, Shawky H, et al. Diaphragmatic nerve palsy after cardiac surgery in children in Egypt:outcome and debate in management. World J Pediatr Congenit Heart Surg, 2013, 4(1):19-23.
6.	Healy F, Hanna BD, Zinman R. Pulmonary complications of congenital heart disease. Paediatr Respir Rev, 2012, 13(1):10-15.
7.	Yemisci OU, Cosar SN, Karatas M, et al. A prospective study of temporal course of phrenic nerve palsy in children after cardiac surgery. J Clin Neurophysiol, 2011, 28(2):222-226.
8.	Zhang YB, Wang X, Li SJ, et al. Postoperative diaphragmatic paral-ysis after cardiac surgery in children:incidence, diagnosis and surgical management. Chin Med J (Engl), 2013, 126(21):4083-4087.
9.	Ling F, Liu YL, Liu AJ, et al. Effects of low potassium dextran glucose solution on oleic acid-induced acute lung injury in juvenile piglets. Chin Med J (Engl), 2011, 124(14):2196-2202.
10.	Akay TH, Ozkan S, Gultekin B, et al. Diaphragmatic paralysis after cardiac surgery in children:incidence, prognosis and surgical management. Pediatr Surg Int, 2006, 22(4):341-346.
11.	李永青, 李守軍, 呂小東, 等.嬰幼兒心臟手術后膈肌麻痹的超聲診斷.中國超聲醫學雜志, 2010, 26(7):631-633.
12.	王玉, 高麗.小潮氣量通氣聯合肺復張策略在治療急性肺損傷患兒中的肺保護作用.實用兒科臨床雜志, 2012, 27(6):433-435.
13.	Refaely Y, Simansky DA, Paley M, et al. Plication of diaphragm for postoperative phrenic nerve injury in infants and young children. Harefuah, 1999, 137(5-6):190-193, 263.
14.	柳濤, 蔡柏薔.膈肌麻痹診治新進展.國際呼吸雜志, 2012, 32(6):476-479.
15.	張燕搏, 王飛燕, 王強, 等.兒童心臟外科重癥監護病房醫院感染臨床研究.中華實用診斷與治療雜志, 2011, 25(5):429-432.
16.	Liu AJ, Ling F, Wang D, et al. Fasudil inhibits platelet-derived growth factor-induced human pulmonary artery smooth muscle cell proliferation by up-regulation of p27kip¹ via the ERK signal pathway. Chin Med J(Engl), 2011, 124(19):3098-3104.
17.	歐陽輝, 鄔曉臣, 丁盛, 等.膈肌折疊術治療嬰幼兒先天性心臟病矯治術后膈肌麻痹的臨床療效分析.中國胸心血管外科臨床雜志, 2014, 21(2):220-223.
18.	Akbariasbagh P, Mirzaghayan MR, Akbariasbagh N, et al. risk factors for post-cardiac surgery diaphragmatic paralysis in children with congenital heart disease. J Tehran Heart Cent, 2015, 10(3):134-139.
19.	Smith BM, Ezeokoli NJ, Kipps AK, et al. Course, predictors of diaphragm recovery after phrenic nerve injury during pediatric cardiac surgery. Ann Thorac Surg, 2013, 96(3):938-942.
20.	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(1):56-61.

1. ?Guillemaud JP, El-Hakim H, Richards S, et al. Airway pathologic abnormalities in symptomatic children with congenital cardiac and vascular disease. Arch Otolaryngol Head Neck Surg, 2007, 133 (7):672-676.
2. Lemmer J, Stiller B, Heise G, et al. Postoperative phrenic nerve palsy:early clinical implications and management. Intensive Care Med, 2006, 32(8):1227-1233.
3. De Leeuw M, Williams JM, Freedom RM, et al. Impact of diaphrag-matic paralysis after cardiothoracic surgery in children. J Thorac Cardiovasc Surg, 1999, 118(3):510-517.
4. Jog SM, Patole SK. Diaphragmatic paralysis in extremely low birth-weight neonates:Is waiting for spontaneous recovery justified? J Paediatr Child Health, 2002, 38(1):101-103.
5. El Tantawy AE, Imam S, Shawky H, et al. Diaphragmatic nerve palsy after cardiac surgery in children in Egypt:outcome and debate in management. World J Pediatr Congenit Heart Surg, 2013, 4(1):19-23.
6. Healy F, Hanna BD, Zinman R. Pulmonary complications of congenital heart disease. Paediatr Respir Rev, 2012, 13(1):10-15.
7. Yemisci OU, Cosar SN, Karatas M, et al. A prospective study of temporal course of phrenic nerve palsy in children after cardiac surgery. J Clin Neurophysiol, 2011, 28(2):222-226.
8. Zhang YB, Wang X, Li SJ, et al. Postoperative diaphragmatic paral-ysis after cardiac surgery in children:incidence, diagnosis and surgical management. Chin Med J (Engl), 2013, 126(21):4083-4087.
9. Ling F, Liu YL, Liu AJ, et al. Effects of low potassium dextran glucose solution on oleic acid-induced acute lung injury in juvenile piglets. Chin Med J (Engl), 2011, 124(14):2196-2202.
10. Akay TH, Ozkan S, Gultekin B, et al. Diaphragmatic paralysis after cardiac surgery in children:incidence, prognosis and surgical management. Pediatr Surg Int, 2006, 22(4):341-346.
11. 李永青, 李守軍, 呂小東, 等.嬰幼兒心臟手術后膈肌麻痹的超聲診斷.中國超聲醫學雜志, 2010, 26(7):631-633.
12. 王玉, 高麗.小潮氣量通氣聯合肺復張策略在治療急性肺損傷患兒中的肺保護作用.實用兒科臨床雜志, 2012, 27(6):433-435.
13. Refaely Y, Simansky DA, Paley M, et al. Plication of diaphragm for postoperative phrenic nerve injury in infants and young children. Harefuah, 1999, 137(5-6):190-193, 263.
14. 柳濤, 蔡柏薔.膈肌麻痹診治新進展.國際呼吸雜志, 2012, 32(6):476-479.
15. 張燕搏, 王飛燕, 王強, 等.兒童心臟外科重癥監護病房醫院感染臨床研究.中華實用診斷與治療雜志, 2011, 25(5):429-432.
16. Liu AJ, Ling F, Wang D, et al. Fasudil inhibits platelet-derived growth factor-induced human pulmonary artery smooth muscle cell proliferation by up-regulation of p27kip¹ via the ERK signal pathway. Chin Med J(Engl), 2011, 124(19):3098-3104.
17. 歐陽輝, 鄔曉臣, 丁盛, 等.膈肌折疊術治療嬰幼兒先天性心臟病矯治術后膈肌麻痹的臨床療效分析.中國胸心血管外科臨床雜志, 2014, 21(2):220-223.
18. Akbariasbagh P, Mirzaghayan MR, Akbariasbagh N, et al. risk factors for post-cardiac surgery diaphragmatic paralysis in children with congenital heart disease. J Tehran Heart Cent, 2015, 10(3):134-139.
19. Smith BM, Ezeokoli NJ, Kipps AK, et al. Course, predictors of diaphragm recovery after phrenic nerve injury during pediatric cardiac surgery. Ann Thorac Surg, 2013, 96(3):938-942.
20. 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(1):56-61.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment of Diaphragmatic Paralysis in Infants with Congenital Heart Disease after Surgery

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