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Long-term fate of the diaphragm surgically plicated during infancy and early childhood
Insights
Transthoracic diaphragmatic plication offers favorable early results for children with phrenic nerve injury. Late-stage follow-up shows a return of normal diaphragm function in most patients studied.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Neurology
Background:
- Phrenic nerve injury can cause significant respiratory issues in children.
- Transthoracic diaphragmatic plication is a known early intervention for symptomatic diaphragmatic dysfunction.
- Long-term functional outcomes after this procedure are not well-documented.
Purpose of the Study:
- To evaluate the late functional results of transthoracic diaphragmatic plication in pediatric patients with phrenic nerve injury.
- To assess diaphragm function recovery in children following this surgical intervention.
Main Methods:
- Retrospective review of 11 pediatric patients with phrenic nerve injury and diaphragmatic dysfunction.
- Diagnosis confirmed by fluoroscopic assessment of paradoxical diaphragmatic motion.
- Diaphragmatic plication performed in infants, with follow-up fluoroscopy 1-7 years post-surgery.
Main Results:
- 11 patients with phrenic nerve injury (10 congenital heart disease, 1 birth trauma) underwent diaphragmatic plication.
- Indications included ventilator dependence and postoperative respiratory distress.
- Postoperative fluoroscopy (1-7 years) showed return of normal diaphragm function in 6 of 6 patients evaluated.
Conclusions:
- Transthoracic diaphragmatic plication is an effective treatment for pediatric phrenic nerve injury.
- The procedure demonstrates sustained positive functional outcomes, including return of normal diaphragm function.
- An aggressive diagnostic and treatment approach since 1980 has improved patient outcomes, reducing ventilation and ICU time.
Abstract:
Favorable early results have been reported utilizing transthoracic diaphragmatic plication in symptomatic children with phrenic nerve injury. However, little has been published about the late functional results of this technique. Since 1976, 10 of 3,000 patients operated on for congenital heart disease have sustained phrenic nerve injury with subsequent respiratory embarrassment. An additional patient sustained phrenic nerve injury as a result of birth trauma. The diagnosis was confirmed by paradoxical diaphragmatic motion on fluoroscopy. All but 2 patients were less than 5 months old at the time of diaphragmatic plication, and the average weight was 5.4 kg. The indication for diaphragmatic plication was inability to wean from the ventilator in 8 of the 11 patients and persistent postoperative tachypnea, stridor, and CO2 retention in the remaining 3 patients. A more aggressive approach to diagnosis and operative treatment since 1980 has resulted in a substantially shorter duration of endotracheal intubation and a shorter stay in the intensive care unit. Diaphragmatic fluoroscopy 1 to 7 years postoperatively has demonstrated return of normal function in 6 of 6 patients studied.