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Hemi-Diaphragm Plication and/or Tracheostomy Are Valuable Adjunctive Procedures After Repair of Congenital Heart

Vishal V Bhende1, Tanishq S Sharma1,2, Mathangi Krishnakumar3

  • 1Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND.

Cureus
|November 13, 2023
PubMed

Insights

Diaphragmatic paralysis (DP) after congenital heart surgery, especially in infants, leads to complications. Early diagnosis and diaphragm repair, alongside careful tracheostomy management, can improve outcomes for pediatric patients.

Area of Science:

  • Pediatric Cardiac Surgery
  • Thoracic Surgery
  • Neonatal Intensive Care

Background:

  • Diaphragmatic paralysis (DP) is a significant complication in neonates and infants undergoing congenital heart surgery (CHD), particularly after single-ventricle palliation.
  • Tracheostomy use is increasing in pediatric CHD patients, associated with high resource use and mortality.

Purpose of the Study:

  • To examine the incidence of DP and tracheostomy timing in pediatric CHD patients.
  • To analyze institutional data (2018-2023) and literature to inform prospective management strategies.

Main Methods:

  • Systematic literature review of PubMed for pediatric tracheostomy and DP studies.
  • Retrospective analysis of 15 pediatric patients with CHD who underwent surgery between 2018 and 2023.

Main Results:

  • Literature review identified 10 studies on pediatric tracheostomy and 11 on DP.
  • Institutional analysis: 10 patients had tracheostomy, 4 had diaphragmatic plication, 1 had both.
  • Postoperative tracheostomy mortality was 11.8% (systematic review) and 40% (observational study).

Conclusions:

  • Diaphragmatic repair and prompt diagnosis are crucial for reducing morbidity and preventing complications.
  • Improved management of DP and tracheostomy can enhance quality of life for pediatric CHD patients.

Keywords:
congenital heart disease(chd)diaphragm palsydiaphragm plicationpediatric critical carepediatricsphrenic nerverespiratory failuresingle-ventricle physiologytracheostomy

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