Diaphragmatic Plication for Acquired Phrenic Nerve Injury after Congenital Cardiac Surgeries

Background: Phrenic nerve injury and diaphragmatic dysfunction are common after pediatric cardiac surgery leading to failure to wean from ventilatory support. Diaphragmatic plication is the standard management of diaphragmatic paralysis. The aim of this retrospective study is to review our experience with diaphragmatic plication and its effect on the operative outcome. Methods: This retrospective cohort study included all patients who underwent diaphragmatic plication from June 2010 to June 2017. Seventy-six patients (2.87%) had unilateral diaphragmatic paralysis following 2646 congenital cardiac procedures. Sixty-four patients (2.4%) underwent diaphragmatic plication. Results: The median age for the patients who had plication was 2.75 months (range 0.5- 36) and 3.7 months (range 0.66 to 123) for non-plicated patients. Thirty-six were males (56.25%), and the most common procedure associated with diaphragmatic plication was modified Blalock Taussig Shunt (n= 13; 20.3%). Left-sided diaphragmatic plication was performed in 44 patients (68.7%). The mean time between the primary surgery and diaphragm plication was 6.42±4.51 days. The mean ventilation period before plication was 4.93±3.71 days, and post plication ventilation median time was 2.11±1.82 days. Two patients (3.1%) required tracheostomy for prolonged respiratory insufficiency. One patient (1.6%) needed surgical revision, and two patients (3.1%) had their diaphragmatic plication during the initial surgery. Conclusion: Diaphragmatic plication is an effective procedure in the management of postoperative diaphragmatic paralysis. We recommend early plication for patients with symptomatic diaphragmatic paralysis causing prolonged ventilation

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Successful treatment of phrenic nerve injury with diaphragmatic plication 5 years after onset: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x211070514 ◽

2022 ◽

Vol 10 ◽

pp. 2050313X2110705

Author(s):

Chihiro Ohashi ◽

Takahiro Uchida ◽

Yugo Tanaka ◽

Yoshimasa Maniwa

Keyword(s):

Cardiac Surgery ◽

Case Report ◽

Nerve Injury ◽

Conservative Management ◽

Phrenic Nerve ◽

Respiratory Symptoms ◽

Rare Case ◽

Diaphragmatic Paralysis ◽

Phrenic Nerve Injury ◽

Diaphragmatic Plication

Diaphragmatic paralysis due to phrenic nerve injury is an occasional complication of cardiothoracic surgery. Although diaphragmatic plication is widely used to treat patients with severe irreversible symptoms, its surgical indication and timing remain controversial. Here, we present a rare case of diaphragmatic paralysis in a 65-year-old woman who underwent cardiac surgery and whose respiratory symptoms worsened despite >5 years of conservative management. Consequently, she underwent diaphragmatic plication using an endostapler to resect the redundant diaphragm, followed by over-suturing of all staple lines. She was discharged without any complications and her symptoms and chest radiography and spirometry results improved postoperatively.

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UNILATERAL PARALYSIS OF THE DIAPHRAGM IN THE NEWBORN INFANT DUE TO PHRENIC NERVE INJURY, WITH AND WITHOUT ASSOCIATED BRACHIAL PALSY

PEDIATRICS ◽

10.1542/peds.9.1.69 ◽

1952 ◽

Vol 9 (1) ◽

pp. 69-76

Author(s):

NATHAN SCHIFRIN

Keyword(s):

Nerve Injury ◽

Newborn Infant ◽

Phrenic Nerve ◽

Muscle Fibers ◽

Diaphragmatic Paralysis ◽

Newborn Period ◽

Phrenic Nerve Injury ◽

Roentgenographic Examination ◽

Stimulation Of

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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Laryngeal Trauma with Phrenic Nerve Injury: A Rare Association

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v25i2.633 ◽

2010 ◽

Vol 25 (2) ◽

pp. 39-41 ◽

Cited By ~ 1

Author(s):

Noor Dina Hashim ◽

Mohd Razif Mohamad Yunus ◽

Marina Mat Baki

Keyword(s):

Nerve Injury ◽

Phrenic Nerve ◽

Conservative Therapy ◽

Diaphragmatic Paralysis ◽

Referral Centre ◽

Tertiary Referral Centre ◽

Respiratory Problems ◽

Laryngeal Trauma ◽

Phrenic Nerve Injury ◽

High Index Of Suspicion

Objective: To share our experience in managing a rare involvement of phrenic nerve injury in laryngeal trauma Methods: Study Design: Case report Setting: Tertiary Referral Centre Patient: One Results: A 23-year-old male sustained blunt laryngeal trauma associated with phrenic nerve injury leading to silent traumatic diaphragmatic paralysis. He underwent tracheotomy and surgical repair of Schaeffer class IV laryngeal injuries, and conservative therapy for the diaphragmatic paralysis, which eventually resolved. Conclusion: Patients with laryngeal trauma may have concomitant phrenic nerve injury causing diaphragmatic paralysis. The diagnosis should be considered particularly if the patient has respiratory problems despite securing the airway by tracheotomy. A high index of suspicion is required in diagnosing such an association. Patients should be closely monitored even though most will recover, as some may present with later morbidities. A search of PubMed and OvidSP using the terms “larynx,” “laryngeal trauma” and “phrenic nerve” did not yield any report of phrenic nerve injury in association with laryngeal trauma. To our knowledge, this is may be the first reported case of phrenic nerve injury in association with blunt laryngeal trauma. Keywords: larynx, trauma, phrenic nerve

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Diaphragm Plication using VATS to Hemi-diaphragmatic Paralysis because of Phrenic Nerve Injury: A Case Report

The Journal of the Japanese Association for Chest Surgery ◽

10.2995/jacsurg.21.038 ◽

2007 ◽

Vol 21 (1) ◽

pp. 38-42

Author(s):

Kota Kariatsumari ◽

Koichi Sakasegawa ◽

Syun-ichi Watanabe ◽

Yoshihiro Nakamura ◽

Kazuhiko Hukumori ◽

...

Keyword(s):

Case Report ◽

Nerve Injury ◽

Phrenic Nerve ◽

Diaphragmatic Paralysis ◽

Phrenic Nerve Injury

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Diaphragmatic paralysis after phrenic nerve injury in newborns

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2019.10.038 ◽

2020 ◽

Vol 55 (2) ◽

pp. 240-244 ◽

Cited By ~ 1

Author(s):

Yazan K. Rizeq ◽

Benjamin T. Many ◽

Jonathan C. Vacek ◽

Audra J. Reiter ◽

Mehul V. Raval ◽

...

Keyword(s):

Nerve Injury ◽

Phrenic Nerve ◽

Diaphragmatic Paralysis ◽

Phrenic Nerve Injury

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Isolated traumatic phrenic nerve injury treated with video-assisted thoracoscopic diaphragmatic plication—a case report

Journal of Thoracic Disease ◽

10.21037/jtd.2018.01.145 ◽

2018 ◽

Vol 10 (3) ◽

pp. E183-E185

Author(s):

Yi-Chien Chang ◽

Hsing-Hsien Wu

Keyword(s):

Case Report ◽

Nerve Injury ◽

Phrenic Nerve ◽

Phrenic Nerve Injury ◽

Video Assisted ◽

Diaphragmatic Plication

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A simple method to detect phrenic nerve impairment during cryoballoon ablation of atrial fibrillation using aVF in the standard surface ECG

European Heart Journal ◽

10.1093/ehjci/ehaa946.0606 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Schaerli ◽

S Knecht ◽

F Spies ◽

A Madaffari ◽

S Osswald ◽

...

Keyword(s):

Atrial Fibrillation ◽

Nerve Injury ◽

Phrenic Nerve ◽

Nerve Palsy ◽

Cryoballoon Ablation ◽

Phrenic Nerve Palsy ◽

Phrenic Nerve Injury ◽

Surface Ecg ◽

The Mean ◽

The Right

Abstract Background Phrenic nerve palsy (PNP) is the most common complication in cryoballoon ablation of atrial fibrillation. Monitoring techniques such as compound motor action potential (CMAP) measurements using additional leads, or catheters positioned in the subdiaphragmatic hepatic vein or the esophagus have demonstrated to be effective to prevent PNP. Purpose This study investigates the safety and feasibility of a simple monitoring strategy using the lead aVF of the standard surface 12 lead ECG for CMAP monitoring to prevent PNP. Methods In 263 continuous patients undergoing cryoballoon ablation, a decapolar catheter was placed in the right subclavian vein to stimulate the phrenic nerve during ablation of the right sided pulmonary veins ([email protected] ms at 60 bpm). Capture was continuously monitored using the CMAP potential in the inferior aVF lead of the surface ECG and manually by palpation of the abdominal movement. The freeze was terminated early if the amplitude of the aVF signal decrease by >25% in three consecutive beats or if the diaphragmatic contraction decreased. Results Phrenic nerve injury documented by a reduction of the signal in aVF was observed in 13 of the 263 patients (5%) during freezes of the right superior pulmonary vein. Reduced diaphragmatic contraction detected by palpation of the abdomen was never observed without previous reduced amplitude in the surface aVF signal and was therefore never the trigger to stop a freeze. In patients with phrenic nerve injury, the mean initial amplitude was 1mV (SD ±0.3mV) and the mean minimal amplitude was 0.3mV (SD ±0.2mV). Mean time to recovery of the aVF amplitude was 160 seconds. Twelve patients (4.6%) showed complete recovery whereas one patient (0.4%) showed only partial recovery, as demonstrated in a sniff test at the end of the procedure. This patient showed no clinical signs of phrenic nerve palsy the following day, and full recovery was demonstrated in a sniff test 3 months later. Conclusion Monitoring of CMAP using the aVF signal from a standard 12-lead ECG during phrenic nerve stimulation to reduce the incidence of phrenic nerve palsy is safe and feasible. This technique is readily available during every standard ablation without placing additional electrodes and more sensitive than manual palpation. aVF signal before and during ablation Funding Acknowledgement Type of funding source: None

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Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.121.010516 ◽

2021 ◽

Author(s):

Christian-H. Heeger ◽

Christian Sohns ◽

Alexander Pott ◽

Andreas Metzner ◽

Osamu Inaba ◽

...

Keyword(s):

Prognostic Factors ◽

Nerve Injury ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Phrenic Nerve ◽

Fourth Generation ◽

Specific Patient ◽

Phrenic Nerve Injury ◽

The Mean

Background: Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce. Methods: The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible. Results: A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 17 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was −49±8 °C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months. Conclusions: The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03645577.

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Bilateral phrenic nerve injury after neck dissection: an uncommon cause of respiratory failure

The Journal of Laryngology & Otology ◽

10.1017/s0022215100133432 ◽

1996 ◽

Vol 110 (3) ◽

pp. 281-283 ◽

Cited By ~ 12

Author(s):

Sandhya Yaddanapudi ◽

S. C. Shah

Keyword(s):

Respiratory Failure ◽

Early Diagnosis ◽

Neck Dissection ◽

Nerve Injury ◽

Phrenic Nerve ◽

Diaphragmatic Paralysis ◽

Carcinoma Larynx ◽

Phrenic Nerve Injury ◽

Portable Ultrasonography

AbstractThe case of a patient with carcinoma larynx who developed diaphragmatic paralysis and post-operative respiratory failure due to bilateral phrenic nerve injury is reported. The use of portable ultrasonography for an early diagnosis of diaphragmatic paralysis is discussed.

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