Plication for diaphragm paralysis after paediatric cardiac surgery: a single-centre experience

Area of Science:

• Cardiothoracic Surgery
• Pediatric Cardiology
• Thoracic Surgery

Background:

• Diaphragm paralysis is a significant complication of congenital heart defect (CHD) surgery.
• It leads to increased morbidity, mortality, and healthcare costs.
• Phrenic nerve injury during surgery is a primary cause.

Purpose of the Study:

• To evaluate the efficacy of diaphragm plication for treating diaphragm paralysis post-pediatric cardiac surgery.
• To report on the outcomes and safety of this surgical intervention.

Main Methods:

• Retrospective review of 23 diaphragm plications in 20 pediatric patients (2012-2022).
• Patients underwent cardiac surgery for CHDs.
• Diagnosis confirmed by clinical presentation and imaging (X-ray, ultrasound, fluoroscopy).

Main Results:

• 23 successful plications performed in 20 patients.
• Mean age: 18.2 months; Mean weight: 8.3 kg.
• Highest incidence (4.6%) in systemic to pulmonary artery shunt patients.
• No mortality observed during a mean follow-up of 4.3 years.

Conclusions:

• Diaphragm plication demonstrates encouraging early results for symptomatic patients.
• Routine evaluation of diaphragmatic function via echocardiography is recommended post-operatively.
• Phrenic nerve palsy can result from surgical trauma (dissection, contusion, thermal injury).