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Pulmonary Function Outcomes in Children Undergoing Diaphragmatic Plication After Phrenic Nerve Palsy Secondary to
Ehsan Aghaei Moghadam1, Yousef Vojgani1, Mahsa Erfanian Salim2
1Fetal and Pediatric Cardiovascular Research Center Children's Medical Center Tehran Iran.
Insights
Diaphragmatic plication in children after heart surgery may cause restrictive lung patterns. While walking capacity is maintained, exercise-induced desaturation occurs, impacting respiratory function long-term.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Phrenic nerve injury is a known complication of pediatric congenital cardiac surgery.
- This can lead to diaphragmatic paralysis and chronic respiratory issues.
- Diaphragmatic plication is a surgical option, but its mid-term effects are not well understood.
Purpose of the Study:
- To evaluate mid-term pulmonary function in children after diaphragmatic plication for phrenic nerve palsy.
- To assess the impact of this procedure on lung mechanics and exercise capacity.
Main Methods:
- Retrospective case series of five children undergoing diaphragmatic plication (2011-2021).
- Pulmonary function tests (spirometry, plethysmography) and 6-minute walk test (6MWT) were performed.
- Results were compared to predicted normative values.
Main Results:
- At a mean 5-year follow-up, forced vital capacity (FVC), forced expiratory volume (FEV1), vital capacity (VC), and total lung capacity (TLC) were significantly reduced compared to predictions.
- FEV1/FVC, residual volume (RV), and forced residual capacity (FRC) showed no significant differences.
- Patients completed the 6MWT, but experienced significant post-exercise oxygen desaturation.
Conclusions:
- Diaphragmatic plication for pediatric phrenic nerve palsy results in a restrictive lung function pattern.
- Despite preserved walking ability, patients exhibit exercise-induced desaturation, indicating persistent respiratory compromise.
Abstract:
Phrenic nerve injury is a recognised complication of congenital cardiac surgery in children, potentially leading to diaphragmatic paralysis and long-term respiratory dysfunction. Diaphragmatic plication is performed to improve lung mechanics, but its mid-term outcomes remain underexplored. The objective was to assess mid-term pulmonary function in children who underwent diaphragmatic plication for phrenic nerve palsy following congenital heart surgery. This retrospective case series included five children who received left diaphragmatic plication between 2011 and 2021 at a tertiary paediatric centre. Pulmonary function was evaluated using spirometry, plethysmography, and the 6-min walk test (6MWT), and compared to predicted normative values. At a mean follow-up of 5 years, forced volume capacity (FVC), forced expiratory volume (FEV1), vital capacity (VC), and total lung capacity (TLC) were significantly lower than predicted (p < 0.05). FEV1/FVC, residual volume (RV), and forced residual capacity (FRC) were not significantly different. All patients completed the 6MWT (> 300 m), though post-exercise oxygen saturation declined significantly (p = 0.011). Diaphragmatic plication leads to a restrictive pattern and exercise-induced desaturation despite preserved walking capacity.
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