scholarly journals A novel sonographic sign of paradoxical movement of diaphragmatic paralysis in pediatric patients after cardiovascular surgery

2021 ◽  
Vol 16 (4) ◽  
pp. 777-784
Author(s):  
Takahiro Hosokawa ◽  
Yutaka Tanami ◽  
Yumiko Sato ◽  
Koji Nomura ◽  
Eiji Oguma
Keyword(s):  
Pediatric Patients ◽  
Cardiovascular Surgery ◽  
Diaphragmatic Paralysis ◽  
Paradoxical Movement ◽  
Sonographic Sign

scholarly journals Ultrasound evaluation of complications after cardiovascular surgery in pediatric patients: A case series

2020 ◽  
Vol 1 (1) ◽  
pp. 108 ◽  
Author(s):  
Takahiro Hosokawa ◽  
Sio Suzuki ◽  
Yutaka Tanami ◽  
Yumiko Sato ◽  
Yoshihiro Ko ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Early Diagnosis ◽  
Radiation Exposure ◽  
Pediatric Patients ◽  
Cardiovascular Surgery ◽  
Case Series ◽  
Early Initiation ◽  
Site Infection ◽  
Ultrasound Evaluation ◽  
Selection Of

In contrast to computed tomography, ultrasound can be performed without radiation exposure, repeatedly performed by the patients’ bedside. Hence, in this case series, we describe the evaluation of complications including hematoma, superficialsurgical site infection, mediastinitis, and pseudoaneurysm associated mediastinitis using ultrasound in pediatric patients after cardiovascular surgery. To our knowledge, no previous reports have evaluated such complications using ultrasound. Ultrasound may be useful for the early diagnosis of these complications, and in the selection of subsequent examinations such as computed tomography, resulting in the early initiation of intervention.

Comparison of sonographic findings between pediatric patients with mediastinitis and without mediastinitis after cardiovascular surgery

2020 ◽  
Vol 47 (4) ◽  
pp. 625-633 ◽  
Author(s):  
Takahiro Hosokawa ◽  
Yutaka Tanami ◽  
Yumiko Sato ◽  
Yoshihiro Ko ◽  
Koji Nomura ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Cardiovascular Surgery

Bilateral diaphragmatic palsy after congenital heart surgery: management options

2015 ◽  
Vol 26 (5) ◽  
pp. 927-930 ◽  
Author(s):  
Pradeep Bhaskar ◽  
Reyaz A. Lone ◽  
Ahmad Sallehuddin ◽  
Jiju John ◽  
Akhlaque N. Bhat ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Recovery Of Function ◽  
Length Of Hospital Stay ◽  
Major Complication ◽  
Congenital Heart Surgery ◽  
Diaphragmatic Paralysis ◽  
Median Length ◽  
Management Options ◽  
Paradoxical Movement

AbstractDiaphragmatic paralysis following phrenic nerve injury is a major complication following congenital cardiac surgery. In contrast to unilateral paralysis, patients with bilateral diaphragmatic paralysis present a higher risk group, require different management methods, and have poorer prognosis. We retrospectively analysed seven patients who had bilateral diaphragmatic paralysis following congenital heart surgery during the period from July, 2006 to July, 2014. Considerations were given to the time to diagnosis of diaphragm paralysis, total ventilator days, interval after plication, and lengths of ICU and hospital stays. The incidence of bilateral diaphragmatic paralysis was 0.68% with a median age of 2 months (0.6–12 months). There was one neonate and six infants with a median weight of 4 kg (3–7 kg); five patients underwent unilateral plication of the paradoxical diaphragm following recovery of the other side, whereas the remaining two patients who did not demonstrate a paradoxical movement were successfully weaned from the ventilator following recovery of function in one of the diaphragms. The median ventilation time for the whole group was 48 days (20–90 days). The median length of ICU stay was 46 days (24–110 days), and the median length of hospital stay was 50 days (30–116 days). None of the patients required tracheostomy for respiratory support and there were no mortalities, although all the patients except one developed ventilator-associated pneumonia. The outcome of different management options for bilateral diaphragmatic paralysis following surgery for CHD is discussed.

scholarly journals Diaphragmatic Paralysis: A Critical Review of its Use as a Therapeutic Measure in Respiratory Disease

1934 ◽  
Vol 27 (12) ◽  
pp. 1555-1562 ◽  
Author(s):  
A. J. Campbell
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lung Volume ◽  
Critical Review ◽  
Diaphragmatic Paralysis ◽  
Bilateral Pneumothorax ◽  
Therapeutic Measure ◽  
Affected Side ◽  
Paradoxical Movement ◽  
Abdominal Palpation ◽  
Lung Hydatid

Diaphragmatic paralysis first suggested as a therapeutic measure in lung disease by Steurtz (1911), who did simple phrenicotomy. Felix (1922) showed in 25% of cases this was ineffective owing to the presence of an accessory phrenic, and suggested phrenic exairesis, i.e. complete evulsion of the phrenic nerve. Goetze (1922) suggested radical phrenicotomy, i.e. division of the phrenic and excision of the nerve to the subclavius. Effects of diaphragmatic paralysis.—The diaphragm rises to the full expiratory position (4–8 cm.). Paradoxical movement (Kienböch's phenomenon) on affected side. Muscle atrophies. Collapse of the lung produced, affecting base and apex also. Lung volume reduced by ⅙th to ⅓rd. Physical signs.—Indrawing of the epigastrium. Thoracic breathing. Litten's sign absent. Less resistance to abdominal palpation on affected side. Diminished resonance at border of sternum and at base. Deficient inspiratory murmur at base. Radiography.—Paradoxical movement. Bittorf's test. Indications.—(A) Pulmonary tuberculosis. I. As the sole therapeutic measure. (1) In cases where pneumothorax has failed. (2) For relief of symptoms such as: ( a) hæmoptysis; ( b) cough; ( c) tachycardia ( d) nausea and vomiting; ( e) pain; ( f) hiccup. II. Combined with pneumothorax. ( a) For basal adhesions; ( b) alternative to bilateral pneumothorax; ( c) to lengthen interval between refills; ( d) at conclusion of pneumothorax treatment. III. Combined with thoracoplasty. (B) Other diseases. Unresolved pneumonia, fibrosis of the lung, bronchiectasis, abscess of the lung, hydatid disease.

scholarly journals Effect of Del Nido cardioplegia on ventricular arrhythmias after cardiovascular surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chang Shu ◽  
Liang Hong ◽  
Xiao Shen ◽  
Wenhao Zhang ◽  
Yongsheng Niu ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Ventricular Arrhythmias ◽  
Pediatric Patients ◽  
Cardiovascular Surgery ◽  
Multivariate Logistic Regression ◽  
Substantial Evidence ◽  
Postoperative Arrhythmia ◽  
Icu Stay ◽  
Medical University ◽  
Length Of Icu Stay

Abstract Background Del Nido cardioplegia (DNC) has been proven safe and effective in pediatric patients. However, the use of DNC in adult undergoing cardiovascular surgery lacks support with substantial evidence. This study aimed to evaluate the efficacy of DNC as a cardioplegia of prophylaxis to ventricular arrhythmias associated to cardiovascular surgery in adult patients. Methods This study recruited nine hundred fifty-four patients who underwent cardiopulmonary bypass surgeries in Nanjing Hospital affiliated to Nanjing Medical University between January 2019 and December 2019. Among 954 patients, 324 patients were treated with DNC (DNC group), and 630 patients were treated with St. Thomas cardioplegia (STH group). The incidence of postoperative arrhythmia as well as other cardiovascular events relavant to the surgery were investigated in both groups. Results In DNC group, the incidence of postoperative ventricular arrhythmias was lower (12.4% vs. 17.4%, P = 0.040), and the length of ICU stay was shorter (1.97 ± 1.49 vs. 2.26 ± 1.46, P = 0.004). Multivariate logistic regression demonstrated that the use of DNC helped to reduce the incidence of postoperative ventricular arrhythmias (adjusted odds ratio 0.475, 95% CI 0.266–0.825, P = 0.010). The propensity score-based analysis and subgroup analysis indicated that DNC has the same protecting effects towards myocardial in all kinds of cardiopulmonary bypass surgeries. Conclusions Del Nido cardioplegia may potentially reduce the incidence of postoperative ventricular arrhythmias, shorten the length of ICU stay and improve the overall outcome of the patients undergoing cardiovascular surgery.

scholarly journals Efficacy of limited cefuroxime prophylaxis in pediatric patients after cardiovascular surgery

2011 ◽  
Vol 68 (10) ◽  
pp. 909-914 ◽  
Author(s):  
Chad A. Knoderer ◽  
Elaine G. Cox ◽  
Michelle D. Berg ◽  
Andrea H. Webster ◽  
Mark W. Turrentine
Keyword(s):  
Pediatric Patients ◽  
Cardiovascular Surgery

Diaphragmatic palsy after cardiac surgery in adult and pediatric patients

2019 ◽  
Vol 27 (6) ◽  
pp. 481-485 ◽  
Author(s):  
Khalid Ebrahim Al-Ebrahim ◽  
Ahmed Abdelrahman Elassal ◽  
Osama Saber Eldib ◽  
Ahmed Hassan Abdelsalam Abdalla ◽  
Amr Ragab Abdelaty Allam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Pediatric Patients ◽  
Treatment Options ◽  
Diaphragmatic Paralysis ◽  
Low Cardiac Output ◽  
Diaphragmatic Palsy ◽  
Median Period ◽  
Adults And Children ◽  
One Year

Background Important differences in the mechanism of respiration between adults and children warrant distinction in the management of diaphragmatic paralysis as a complication of cardiac surgery. We describe the management and outcomes of this complication in both groups. Methods We retrospectively analyzed 16 patients (5 adults and 11 children) with diaphragmatic paralysis after cardiac surgery performed between 2008 and 2018. Clinical examination, chest radiography, and confirmation with fluoroscopy in selected cases were our modalities of diagnosis. All adults were managed conservatively, whereas plication was performed in all children. Results The incidence of diaphragmatic paralysis was 0.98% in pediatric patients and 0.43% in adults. The mean age was 2.33 ± 2.59 years in children and 53.2 ± 17.99 years in adults. All adults were symptomatic. All children showed difficulty in weaning from mechanical ventilation after cardiac surgery. The period of mechanical ventilation before plication was 2–6 days (median 4 days). Death occurred as a result of low cardiac output in a 10-year-old boy, and due to respiratory failure in a 30-year-old woman. Children were successfully weaned from mechanical ventilation after diaphragmatic plication. The median time to extubation after plication was 2.5 days (range 1–13 days). The median period of recovery in adults was 52 days (range 32–85 days). All survivors had acceptable outcomes at 6 months to one year. Conclusion Conservative management in adults and early plication in children are viable treatment options for diaphragmatic palsy after cardiac surgery, with acceptable outcomes.

scholarly journals Extracardiac Complications in Intensive Care Units after Surgical Repair for Congenital Heart Disease: Imaging Review with a Focus on Ultrasound and Radiography

2020 ◽  
Author(s):  
Takahiro Hosokawa ◽  
Saki Shibuki ◽  
Yutaka Tanami ◽  
Yumiko Sato ◽  
Yoshihiro Ko ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Pediatric Patients ◽  
Cardiovascular Surgery ◽  
Surgical Repair ◽  
Lung Parenchyma ◽  
Medical Doctors ◽  
Iatrogenic Complications ◽  
Pictorial Review ◽  
The Central Nervous System

AbstractPediatric patients show various extracardiac complications after cardiovascular surgery, and radiography and ultrasound are routinely performed in the intensive care unit to detect and evaluate these complications. This review presents images of these complications, sonographic approach, and timing of occurrence that are categorized based on their extracardiac locations and include complications pertaining to the central nervous system, mediastinum, thorax and lung parenchyma, diaphragm, liver and biliary system, and kidney along with pleural effusion and iatrogenic complications. This pictorial review will make it easier for medical doctors in intensive care units to identify and manage various extracardiac complications in pediatric patients after cardiovascular surgery.

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