Abstract

BRAVO PEREZ DE ORDAZ, Luis; OZORES SUAREZ, Javier  and  MIRANDA PEREZ, Yosnaiby. Incidence of diaphragmatic paralysis after cardiac surgery. Rev Cubana Pediatr [online]. 2007, vol.79, n.4. ISSN 0034-7531.

The phrenic nerve injury due to cardiac surgery is the main cause of diaphragmatic paralysis in children. The incidence of this affection after cardiac surgery was determined, and the clinical evolution and surgical treatment applied to these patients were evaluated. A retrospective analysis of 8 patients with diaphragmatic paralysis operated on in a period of 26 months was made. The incidence of diaphragmatic paralysis was 8/651 (1.2 %). Blalock Taussings shunt was the causing surgical procedure in 4 patients (50 %), accounting for an incidence of 4/63 (6.3 %). 42.8 % of the patients had underwent previous thoracic surgery. Diaphragmatic plication was carried out in 5 patients (62.5 %). The mean time between heart surgery and plication was 3 days (range 2-23 days). The mean time of mechanical ventilation after heart surgery was 10 days (range 5-33 days) among patients with plication, and of 6 days  (range 19 hours-12 days) in patients without plication (p = 0.39). The mean age of the patients requiring plication was 1 month (range 10 days 18 months), whereas in the rest it was 84 months (range 4-100 months) (p = 0.04). The mean time between plication and successful extubation was 3.5 days (range 3-10 days). The mortality in patients with diaphragmatic paralysis was 25 % (2 patients). Diaphragmatic paralysis was a common complication, and the systemic-pulmonary shunt was the most important associated surgical procedure. Mortality was high in spite of the fact that diaphragmatic plication was performed early.

Keywords : Diaphragmatic paralysis; diaphragmatic plication; cardiac surgery.

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