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Transient phrenic nerve palsy after cardiac operation in infants
Tomihiro Imai1, Hirohiko Shizukawa, Hitoshi Imaizumi
1Department of Neurology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan. toimai@sapmed.ac.jp
Insights
Transient phrenic nerve palsy is common in infants after cardiac surgery. Persistent diaphragmatic action potential abnormalities for two weeks indicate the need for diaphragmatic plication.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Clinical Electrophysiology
Background:
- Phrenic nerve palsy can occur in infants following cardiac surgery.
- Diaphragmatic action potentials (DAPs) are crucial for assessing diaphragm function.
Purpose of the Study:
- To confirm transient phrenic nerve palsy in pediatric cardiac surgery patients using DAP recordings.
- To establish criteria for diaphragmatic plication in infants with postoperative phrenic nerve palsy.
Main Methods:
- Diaphragmatic action potentials (DAPs) were recorded in 11 infants post-cardiac surgery.
- Recordings were taken at 0W, 1W, and 2W post-operation to assess nerve recovery.
- Decision for diaphragmatic plication was based on serial DAP assessments.
Main Results:
- Three patient groups emerged based on DAP changes: normal, transiently depressed with recovery, and persistently depressed.
- Persistent DAP depression in affected hemidiaphragm necessitated diaphragmatic plication.
- Serial DAP recordings guided treatment decisions.
Conclusions:
- Persistently abnormal DAPs for at least two weeks post-surgery are indicative of phrenic nerve palsy in infants.
- Repeated electrophysiologic examinations support clinical and radiological findings for diaphragmatic plication.
- DAP monitoring is valuable for managing phrenic nerve palsy after pediatric cardiothoracic surgery.
Objective:
The aims of this study were to prove the presence of transient phrenic nerve palsy in children after cardiac surgery by successive recordings of diaphragmatic action potentials (DAPs), and to decide the indication of diaphragmatic plication in infants with postoperative phrenic nerve palsy.
Methods:
The DAPs were recorded from 11 infants (age 0-54 months) under artificial ventilation after cardiac surgery. The successive DAP recordings were performed within 3-4 days (0W), 1 week (1W) and 2 weeks (2W) after operation to make a final decision for diaphragmatic plication to wean artificial ventilation.
Results:
The patients were divided into 3 groups according to the DAP changes in successive recordings, namely, patients with normal DAPs at 0W, patients with transient depression of DAPs at 0W followed by recovery to normal DAPs by 1W and/or 2W, and patients with persistent depression of DAPs of the affected side necessitating plication of hemidiaphragm.
Conclusions:
In infants with phrenic nerve palsy after cardiothoracic surgery, persistently abnormal DAPs in repeated electrophysiologic examinations for at least 2 weeks after surgery are a useful guidance to support clinical and radiological evidence for an indication of diaphragmatic plication.
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