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[Diaphragmatic paralysis in the postoperative period after heart surgery in children]
P Vázquez López1, C Medrano López, M Serrano Madrid
1Departamento de Pediatría y Cirugía Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid.
Insights
Diaphragmatic paralysis (DP) is a rare complication following pediatric cardiac surgery, occurring in 2.3% of cases. Suspect DP in infants with unexplained respiratory weaning difficulties after heart operations.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Critical Care Medicine
Context:
- Pediatric cardiac surgery involves complex procedures on young patients.
- Post-operative complications can significantly impact recovery and outcomes.
- Diaphragmatic paralysis (DP) is a potential, though infrequent, complication.
Purpose:
- To determine the incidence of diaphragmatic paralysis (DP) after pediatric cardiac surgery.
- To analyze the pathological features, clinical relevance, and treatment of DP.
- To enhance understanding of this rare complication for improved patient care.
Summary:
- Diaphragmatic paralysis (DP) was diagnosed in 13 out of 556 pediatric patients (2.3%) undergoing cardiac surgery.
- Commonly associated procedures included atrial septal defect closure and systemic-pulmonary shunts.
- Diagnosis via chest X-ray, confirmed with fluoroscopy or ultrasound, led to interventions like mechanical ventilation or diaphragmatic plication, with no long-term sequelae observed.
Impact:
- Highlights the importance of suspecting diaphragmatic paralysis in pediatric cardiac surgery patients with weaning difficulties.
- Provides incidence data and identifies associated surgical procedures.
- Informs clinical suspicion and diagnostic approaches for this rare post-operative complication.
Objective:
The purpose of our study was to determine the incidence, pathological features, clinical relevance and treatment of diaphragmatic paralysis (DP) after pediatric cardiac surgery.
Patients And Methods:
Five hundred fifty-six children who had undergone cardiac surgery between 1990 and 1994 were retrospectively analyzed. Persistent raising of one or both hemidiaphragms on chest x-ray films lead to the diagnosis in all cases.
Results:
Diaphragmatic paralysis was diagnosed in 13 patients (2.3%) ranging from 3 days to 13 years of age. Atrial septal defect closure (3 cases) and systemic-pulmonary shunt derivations (3 cases) were the type of operations most frequently involved. The other cases included, 2 arterial switch in transposition of the great vessels, 1 repair of total anomalous pulmonary venous drainage, 1 tetralogy of Fallot repair, 1 coarctation and aortic stenosis repair, 1 resection of subpulmonary stenosis of transposition of the great vessels and 1 pacemaker implantation. There was no significant association with the use of extracorporeal circulation. There were seven cases of right hemidiaphragmatic paralysis, but no bilateral paralysis was found. Ipsilateral thoracotomy section concordance was found in all patients and no relation with central venous line placement was found. Diagnosis was made by chest x-ray in all cases, and further confirmation was done using fluoroscopy in 6 patients and ultrasound studies in 2. Prolonged mechanical ventilation was needed in 3 patients, and one patient required diaphragmatic plication. No long term complications were found.
Conclusions:
Diaphragmatic paralysis is a rare complication of pediatric cardiac surgery which must be suspected when failed attempts of respiratory weaning, not attributable to cardiac or pulmonary problems, are present.