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[Bilateral phrenic nerve paralysis after heart surgery]

Y M Guillou1, Y Malledant, J P Bleichner

  • 1Service d'Anesthésie-Réanimation Chirurgicale, CHRU Pontchaillou, Rennes.

Annales De Chirurgie
|January 1, 1994
PubMed
Summary

A rare case of bilateral phrenic nerve paralysis occurred after open heart surgery. This complication led to prolonged mechanical ventilation and incomplete recovery of diaphragm function.

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Area of Science:

  • Cardiology
  • Neurology
  • Thoracic Surgery

Background:

  • Open heart surgery, particularly aortic valve replacement, carries potential risks.
  • Cold cardioplegia is a standard technique in cardiac surgery.
  • Phrenic nerve injury can lead to diaphragmatic dysfunction.

Observation:

  • A 78-year-old patient developed bilateral phrenic nerve paralysis post-aortic valve replacement.
  • The paralysis occurred despite the absence of direct surgical trauma or ice slush application.
  • Clinical and radiological signs suggested phrenic dysfunction.

Findings:

  • Portable sonography aided in diagnosing phrenic dysfunction.
  • Diaphragmatic compound muscle action potential measurements confirmed nerve injury.

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  • The patient required 68 days of mechanical ventilation.

    • Implications:

    • This case highlights a potential complication of cold cardioplegia during cardiac surgery.
    • Early diagnosis using sonography and electrophysiological tests is crucial.
    • Prolonged ventilation and incomplete recovery underscore the severity of this neuropathy.