Exercise Therapy for a Patient With Persistent Dyspnea After Combined Traumatic Diaphragmatic Rupture and Phrenic Nerve Injury

The literature on diaphragmatic paralysis in the newborn infant due to phrenic nerve injury is reviewed. Four additional cases are described. Fluoroscopic as well as roentgenographic examination of the chest is urged in the diagnosis of thoracic pathology in the newborn period. Stimulation of the phrenic nerve is believed to be an aid in determining the prognosis. If the diaphragm contracts one can infer that the nerve is intact below the level of stimulation and that the diaphragm has not undergone atrophy of disuse, and that the muscle fibers are capable of contraction when adequately stimulated. Failure of the diaphragm to contract means that the nerve has been compromised below the level of stimulation or that the muscle fibers of the diaphragm are too atrophic to contract. The prognosis in the latter cases must be guarded.

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Abstract 13686: Increased Right Superior Pulmonary Vein Ovality is Associated With Phrenic Nerve Injury in Patients Undergoing Cryoablation for Atrial Fibrillation

Circulation ◽

10.1161/circ.142.suppl_3.13686 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Aditi S Vaishnav ◽

Kristie M Coleman ◽

Parth Makker ◽

Moussa Saleh ◽

Kabir Bhasin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Nerve Injury ◽

Phrenic Nerve ◽

Pulmonary Veins ◽

Access Site ◽

Cross Sectional ◽

Phrenic Nerve Injury ◽

Diaphragmatic Palsy ◽

Significant Difference ◽

Shape Effects

Introduction: Success of cryoablation for atrial fibrillation (AF) requires creation of continuous, circumferential lesions around the pulmonary veins (PVs). The depth of these cryo-lesions depends on tissue contact, balloon location, ablation duration and nadir temperature. An optimum lesion depth must be achieved such that effective isolation occurs without collateral cryothermal damage to surrounding structures eg, phrenic nerve injury (PNI). Hypothesis: Increased RSPV ovality results in poor pairing between the balloon and PV, which may cause deeper freezing at the lateral circumference of the PV antrum, near the course of the phrenic nerve, resulting in PNI. Methods: Consecutive patients undergoing cryoablation for paroxysmal/persistent AF were included. Pre-procedural cardiac CT scans were analyzed to evaluate PV size (diameters, cross-sectional area, circumference) and ovality (ratio of maximum:minimum diameter (d max :d min ), shape). Effects of these anatomic characteristics on rates of complications were analyzed. Results: RSPVs from 310 patients (age 65.2 years, 38.1% female, 43.2% persAF) were studied. RSPVs were the largest of the 4 normal PVs (d max 21.5±4 mm; d min 17.8±3.8 mm; area 309±113 mm 2 ; circumference 124.2±22.8 mm). A majority of RSPVs were round (57.3% round, 26.9% oval and 15.9% flat), with median d max :d min = 1.18 [1.1-1.32]. PNI was the 2nd most common complication (after access-site complications). Transient diaphragmatic palsy occurred in 2.9% of patients; there were no cases of complete or persistent diaphragmatic paralysis. Patients in whom diaphragmatic palsy occurred had more oval veins (median d max :d min 1.35 [1.23-1.5] vs 1.18 [1.1-1.31]; p=0.015). Additionally, there was a significant difference in the proportion of patients with round RSPVs who had diaphragmatic palsy (1.1%) compared to those with oval or flat RSPVs (5.3%) (p=0.029) (Fig). Conclusion: Increased RSPV ovality is associated with phrenic nerve injury.

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