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Hemidiaphragm plication after repair of congenital heart defects in children: quantitative return of diaphragm
Craig J Baker1, Valy Boulom, Brian L Reemtsen
1Department of Cardiothoracic Surgery, University of Southern California Keck School of Medicine, Los Angeles, Calif 90033, USA. cbaker@surgery.usc.edu
Insights
Diaphragm plication surgery helps children recover diaphragm function after congenital heart defect repair. This study shows plicated diaphragms regain significant function over time, improving outcomes.
Area of Science:
- Pediatric Surgery
- Cardiothoracic Surgery
- Respiratory Physiology
Background:
- Phrenic nerve injury causing hemidiaphragm paresis is a complication in children after congenital heart defect (CHD) repair.
- While diaphragm plication offers short-term benefits, the long-term return of diaphragm function remains poorly understood.
Purpose of the Study:
- To evaluate the functional recovery of the diaphragm after plication in pediatric patients who experienced hemidiaphragm paresis post-CHD repair.
- To quantify the degree of diaphragm function return using fluoroscopic measurements.
Main Methods:
- Retrospective review of 46 pediatric patients undergoing diaphragm plication following CHD repair.
- Fluoroscopic assessment of diaphragm motion, comparing the plicated side to the contralateral side.
Main Results:
- Hemidiaphragm paresis occurred in 70% of patients on the left side, with injury documented a median of 8 days post-operation.
- Diaphragm plication led to timely extubation in most patients (41/46), with a median recovery time of 16.4 months.
- Plicated diaphragms showed significant excursion, averaging 77% of the contralateral side, with a trend toward improved function over time.
Conclusions:
- Hemidiaphragm paresis significantly increases morbidity in children undergoing CHD repair.
- Early diagnosis and diaphragm plication facilitate prompt extubation.
- This study provides the first quantitative evidence of diaphragm function recovery after plication, suggesting potential for improvement over time.
Objective:
Phrenic nerve injury resulting in hemidiaphragm paresis leads to morbidity in children undergoing repair of congenital heart defects. Previous studies have documented short-term benefits of diaphragm plication, but little is known about the return of diaphragm function.
Methods:
We reviewed 46 consecutive patients undergoing hemidiaphragm plication after repair of congenital heart defects. The function of plicated diaphragms was measured at follow-up fluoroscopy using excursion of the unplicated side as a control.
Results:
The median age at the procedure resulting in phrenic nerve injury was 6.4 months (0-62 months). Among the 46 patients, 29 (63%) and 17 (37%) had repair for single and 2-ventricle defects, respectively. Hemidiaphragm paresis occurred on the left side in 32 patients (70%). Phrenic nerve injury was documented at a median of 8 days (1-84 days) after operation. The median time from diagnosis to plication was 2 days (0-21 days). Five patients required prolonged ventilation after plication. One patient died 10 weeks later, and 4 patients required tracheostomy. The remaining 41 patients were extubated within 2 days (0-19 days). In 17 patients, fluoroscopy assessing diaphragm motion was performed at a mean interval of 16.4 months after plication. Excursion of the plicated diaphragm was 77% of the contralateral side. There was a trend toward improved function over time.
Conclusions:
Hemidiaphragm paresis results in significant morbidity after repair of congenital heart defects. Early diagnosis and plication result in timely extubation. The plicated diaphragm demonstrates return of function that may improve over time. This is the first study to numerically quantitate the degree of diaphragm recovery.
