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Hemidiaphragmatic paralysis increases postoperative morbidity after a modified Fontan operation
Z Amin1, D B McElhinney, J K Strawn
1Joint Division of Pediatric Cardiology, University of Nebraska, Omaha 68114, USA. zamin@chsomaha.org
The Journal of Thoracic and Cardiovascular Surgery
|November 2, 2001
Summary
Hemidiaphragmatic paralysis after Fontan surgery increases early complications like longer hospital stays and ascites. Avoiding phrenic nerve injury is crucial, and prolonged effusions warrant evaluation for paralysis.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Critical Care Medicine
Background:
- The Fontan procedure is a critical surgery for single-ventricle congenital heart defects.
- Negative intrathoracic pressure during inspiration normally augments pulmonary blood flow post-Fontan.
- Hemidiaphragmatic paralysis impairs this augmentation, potentially affecting postoperative outcomes.
Purpose of the Study:
- To compare early postoperative morbidity in patients undergoing the modified Fontan operation.
- To assess the impact of hemidiaphragmatic paralysis on outcomes following the Fontan procedure.
Main Methods:
- A case-control study compared 10 patients with hemidiaphragmatic paralysis to 30 matched controls.
- Outcomes assessed included ventilator support duration, hospital stay, ascites, pleural effusions, and readmission.
Main Results:
- Patients with hemidiaphragmatic paralysis experienced significantly longer hospital stays (25.4 vs 10.8 days).
- Higher incidences of ascites (70% vs 3%), prolonged pleural effusions (60% vs 13%), and readmission (50% vs 7%) were observed in the paralysis group.
- No significant preoperative differences were noted between the groups.
Conclusions:
- Hemidiaphragmatic paralysis is linked to increased early morbidity after the modified Fontan operation.
- Preventing phrenic nerve injury during surgery is essential.
- Consider evaluating for hemidiaphragmatic paralysis in patients with prolonged pleural effusions.
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