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Br Heart J. 1991 May; 65(5): 287–292.
PMCID: PMC1024633

Phrenic nerve injury in infants and children undergoing cardiac surgery.

Abstract

Fifty infants and 50 children less than 15 years undergoing palliative or corrective cardiac surgery in the Brompton Hospital between March and October 1988 had direct percutaneous stimulation of the phrenic nerve before and after operation. Ten patients, six under 1 year of age and four over, developed unilateral phrenic nerve injury. In those aged less than 1 year recovery after operation was prolonged because their diaphragmatic palsy made it difficult to wean them from the ventilator. Older children had symptoms but their rate of recovery did not seem to be affected by the phrenic nerve injury. Phrenic nerve damage was no more frequent after a lateral thoracotomy than after a median sternotomy. There was no significant association with the type of operation performed, the experience of the surgeon, the use of bypass or topical ice, the duration of bypass, circulatory arrest or aortic cross clamping, or the age of the patient at the time of operation. In patients who had cardiopulmonary bypass the risk of injury was significantly higher in those who had undergone previous operation. The 10% frequency of phrenic nerve injury determined in this prospective study was higher than that seen in earlier retrospective reports. Direct percutaneous stimulation of the phrenic nerve can be used at the bedside in infants and children to facilitate early and accurate diagnosis of phrenic nerve palsy, and the results may influence early management.

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Selected References

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  • Sethi G, Reed WA. Diaphragmatic malfunction in neonates and infants. Diagnosis and treatment. J Thorac Cardiovasc Surg. 1971 Jul;62(1):138–143. [PubMed]
  • Mearns AJ. Iatrogenic injury to the phrenic nerve nerve in infants and young children. Br J Surg. 1977 Aug;64(8):558–560. [PubMed]
  • Lynn AM, Jenkins JG, Edmonds JF, Burns JE. Diaphragmatic paralysis after pediatric cardiac surgery: a retrospective analysis of 34 cases. Crit Care Med. 1983 Apr;11(4):280–282. [PubMed]
  • Watanabe T, Trusler GA, Williams WG, Edmonds JF, Coles JG, Hosokawa Y. Phrenic nerve paralysis after pediatric cardiac surgery. Retrospective study of 125 cases. J Thorac Cardiovasc Surg. 1987 Sep;94(3):383–388. [PubMed]
  • Mickell JJ, Oh KS, Siewers RD, Galvis AG, Fricker FJ, Mathews RA. Clinical implications of postoperative unilateral phrenic nerve paralysis. J Thorac Cardiovasc Surg. 1978 Sep;76(3):297–304. [PubMed]
  • Zhao HX, D'Agostino RS, Pitlick PT, Shumway NE, Miller DC. Phrenic nerve injury complicating closed cardiovascular surgical procedures for congenital heart disease. Ann Thorac Surg. 1985 May;39(5):445–449. [PubMed]
  • Davis JN. Phrenic nerve conduction in man. J Neurol Neurosurg Psychiatry. 1967 Oct;30(5):420–426. [PMC free article] [PubMed]
  • McKenzie DK, Gandevia SC. Phrenic nerve conduction times and twitch pressures of the human diaphragm. J Appl Physiol (1985) 1985 May;58(5):1496–1504. [PubMed]
  • Markand ON, Kincaid JC, Pourmand RA, Moorthy SS, King RD, Mahomed Y, Brown JW. Electrophysiologic evaluation of diaphragm by transcutaneous phrenic nerve stimulation. Neurology. 1984 May;34(5):604–614. [PubMed]
  • Mier A, Brophy C, Moxham J, Green M. Phrenic nerve stimulation in normal subjects and in patients with diaphragmatic weakness. Thorax. 1987 Nov;42(11):885–888. [PMC free article] [PubMed]
  • Estenne M, Yernault JC, De Smet JM, De Troyer A. Phrenic and diaphragm function after coronary artery bypass grafting. Thorax. 1985 Apr;40(4):293–299. [PMC free article] [PubMed]
  • Markand ON, Moorthy SS, Mahomed Y, King RD, Brown JW. Postoperative phrenic nerve palsy in patients with open-heart surgery. Ann Thorac Surg. 1985 Jan;39(1):68–73. [PubMed]
  • Russell RI, Mulvey D, Laroche C, Shinebourne EA, Green M. Bedside assessment of phrenic nerve function in infants and children. J Thorac Cardiovasc Surg. 1991 Jan;101(1):143–147. [PubMed]
  • Laroche CM, Carroll N, Moxham J, Green M. Clinical significance of severe isolated diaphragm weakness. Am Rev Respir Dis. 1988 Oct;138(4):862–866. [PubMed]
  • Laroche CM, Mier AK, Moxham J, Green M. Diaphragm strength in patients with recent hemidiaphragm paralysis. Thorax. 1988 Mar;43(3):170–174. [PMC free article] [PubMed]
  • Kohorst WR, Schonfeld SA, Altman M. Bilateral diaphragmatic paralysis following topical cardiac hypothermia. Chest. 1984 Jan;85(1):65–68. [PubMed]
  • Chandler KW, Rozas CJ, Kory RC, Goldman AL. Bilateral diaphragmatic paralysis complicating local cardiac hypothermia during open heart surgery. Am J Med. 1984 Aug;77(2):243–249. [PubMed]
  • Muller NL, Bryan AC. Chest wall mechanics and respiratory muscles in infants. Pediatr Clin North Am. 1979 Aug;26(3):503–516. [PubMed]
  • Green M, Moxham J. The respiratory muscles. Clin Sci (Lond) 1985 Jan;68(1):1–10. [PubMed]
  • SHEPHERD JT. CHANGES IN TONE OF LIMB VEINS DURING SUPINE EXERCISE. J Appl Physiol. 1965 Jan;20:1–8. [PubMed]
  • Clague HW, Hall DR. Effect of posture on lung volume: airway closure and gas exchange in hemidiaphragmatic paralysis. Thorax. 1979 Aug;34(4):523–526. [PMC free article] [PubMed]
  • Keens TG, Bryan AC, Levison H, Ianuzzo CD. Developmental pattern of muscle fiber types in human ventilatory muscles. J Appl Physiol Respir Environ Exerc Physiol. 1978 Jun;44(6):909–913. [PubMed]
  • Marco JD, Hahn JW, Barner HB. Topical cardiac hypothermia and phrenic nerve injury. Ann Thorac Surg. 1977 Mar;23(3):235–237. [PubMed]
  • Dureuil B, Viirès N, Pariente R, Desmonts JM, Aubier M. Effects of phrenic nerve cooling on diaphragmatic function. J Appl Physiol (1985) 1987 Nov;63(5):1763–1769. [PubMed]
  • Rousou JA, Parker T, Engelman RM, Breyer RH. Phrenic nerve paresis associated with the use of iced slush and the cooling jacket for topical hypothermia. J Thorac Cardiovasc Surg. 1985 Jun;89(6):921–925. [PubMed]
  • Wheeler WE, Rubis LJ, Jones CW, Harrah JD. Etiology and prevention of topical cardiac hypothermia-induced phrenic nerve injury and left lower lobe atelectasis during cardiac surgery. Chest. 1985 Nov;88(5):680–683. [PubMed]
  • Esposito RA, Spencer FC. The effect of pericardial insulation on hypothermic phrenic nerve injury during open-heart surgery. Ann Thorac Surg. 1987 Mar;43(3):303–308. [PubMed]
  • Merav AD, Attai LA, Condit DD. Successful repair of a transected phrenic nerve with restoration of diaphragmatic function. Chest. 1983 Nov;84(5):642–644. [PubMed]
  • Stewart S, Alexson C, Manning J. Bilateral phrenic nerve paralysis after the Mustard procedure. Experience with four cases and recommendations for management. J Thorac Cardiovasc Surg. 1986 Jul;92(1):138–141. [PubMed]

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