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Management of phrenic nerve injury post-cardiac surgery in the paediatric patient

Part of: Surgery

Published online by Cambridge University Press:  26 July 2021

Abdulla Tarmahomed ,
Ahmed Adan ,
Ashvin Thomas ,
Ria Sanghavi ,
Kiran Amin ,
Waleed Asif ,
Ashleigh Pittams  and
Amer Harky Open the ORCID record for Amer Harky [Opens in a new window]
Abdulla Tarmahomed
Affiliation:
Department of Paediatric Cardiology, Alder Hey Children’s Hospital, Liverpool, UK
Ahmed Adan
Affiliation:
School of Medicine, University of Liverpool, LiverpoolL69 3GE, UK
Ashvin Thomas
Affiliation:
Faculty of Medicine, Imperial College London, LondonSW7 2AZ, UK
Ria Sanghavi
Affiliation:
School of Medicine, University of Central Lancashire, PrestonPR1 7BH, UK
Kiran Amin
Affiliation:
St George’s University of London, LondonSW17 0RE, UK
Waleed Asif
Affiliation:
School of Medicine, University of Liverpool, LiverpoolL69 3GE, UK
Ashleigh Pittams
Affiliation:
Royal Sussex County Hospital, BrightonBN2 5BE, UK
Amer Harky*
Affiliation:
Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, LiverpoolL14 3PE, UK Department of Paediatric Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK
*
Author for correspondence: Amer Harky, MBChB, MRCS, MSc, Liverpool Heart and Chest Hospital, Thomas drive, LiverpoolL14 3PE, UK. Tel: +44 151 600 1616. E-mail: [email protected]
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Abstract

Background:

Phrenic nerve injury is a common complication of cardiac and thoracic surgical procedures, with potentially severe effects on the health of a child. This review aims to summarise the available literature on the diagnosis and management of PNI post-cardiac surgery in paediatric patients with CHD.

Main body:

The presence of injury post-surgery can be difficult to detect and may present with non-specific symptoms, emphasising the importance of an effective diagnostic strategy. Chest X-ray is usually the first investigation for a suspected diagnosis of PNI, which is usually confirmed using fluoroscopy, ultrasound scan, or phrenic nerve stimulation (gold standard). Management options include supportive ventilation and/or invasive diaphragmatic plication surgery. While the optimal timing of plication surgery remains controversial, it is now the most widely accepted treatment for PNI in children post-CHD surgery, especially for very young patients who cannot be weaned off supportive ventilation. Further research is needed to determine the optimal timing of surgical intervention for positive outcomes and to explore the benefits of using minimally invasive surgical techniques in children.

Conclusion:

PNI is a common and serious complication of CHD surgery, therefore, its diagnosis and management in the paediatric population are of major importance. Further research is needed to determine the optimal timing of surgical intervention for positive outcomes and to explore the benefits of using minimally invasive surgical techniques in children.

Keywords

Phrenic nervecardiac surgery
Type
Review
Information
Cardiology in the Young , Volume 31 , Issue 9 , September 2021 , pp. 1386 - 1392
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Mandoorah, S, Mead, T. Phrenic Nerve Injury, 2020, [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK482227/ Google Scholar
Akbariasbagh, P, Reza Mirzaghayan, M, Akbariasbagh, N, Shariat, M, Ebrahim, B. Risk Factors For Post-Cardiac Surgery Diaphragmatic Paralysis In Children With Congenital Heart Disease, 2015, [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685369/ Google Scholar
de Leeuw, M, Williams, J, Freedom, R, Williams, W, Shemie, S, McCrindle, B. Impact of diaphragmatic paralysis after cardiothoracic surgery in children. J Thorac Cardiovasc Surg 1999; 118: 510–517.CrossRefGoogle ScholarPubMed
Talwar, S, Agarwala, S, Mittal, C, Choudhary, S, Airan, B. Diaphragmatic palsy after cardiac surgical procedures in patients with congenital heart. Ann Pediatr Cardiol 2010; 3: 50.CrossRefGoogle ScholarPubMed
Joho-Arreola, A, Bauersfeld, U, Stauffer, U, Baenziger, O, Bernet, V. Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children. Eur J Cardiothorac Surg 2005; 27: 53–57.CrossRefGoogle ScholarPubMed
Oliver, K, Ashurst, J (2020, Anatomy, Thorax, Phrenic Nerves. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK513325/ Google Scholar
Ostrowska, M, de Carvalho, M. Injuries of the nerves of the thorax, Nerves and Nerve Injuries. Academic Press, London, 2015, p. 525–543.CrossRefGoogle Scholar
Zhang, YB, Xu, WA, Li, SJ, Yang, KM, Sheng, XD, Jun, YA. Postoperative diaphragmatic paralysis after cardiac surgery in children: incidence, diagnosis and surgical management. Chin Med J 2013; 126: 4083–4087.Google ScholarPubMed
Georgiev, S, Konstantinov, G, Latcheva, A, Mitev, P, Mitev, I, Lazarov, S. Phrenic nerve injury after paediatric heart surgery: is aggressive plication of the diaphragm beneficial? Eur J Cardiothorac Surg. 2013; 44: 808–812.CrossRefGoogle ScholarPubMed
Akay, TH, Ozkan, S, Gultekin, B, et al. Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management. Pediatr Surg Int 2006; 22: 341–346.CrossRefGoogle ScholarPubMed
Dubé, B, Dres, M. Diaphragm dysfunction: diagnostic approaches and management strategies. J Clin Med 2016; 5: 113.CrossRefGoogle ScholarPubMed
Houston, J, Fleet, M, Cowan, M, McMillan, N. Comparison of ultrasound with fluoroscopy in the assessment of suspected hemidiaphragmatic movement abnormality. Clin Radiol 1995; 50: 95–98.CrossRefGoogle ScholarPubMed
Zambon, M, Greco, M, Bocchino, S, Cabrini, L, Beccaria, P, Zangrillo, A. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intens Care Med 2016; 43: 29–38.CrossRefGoogle ScholarPubMed
Who.int. WHO | Fluoroscopy, 2020, [online] Available at: https://www.who.int/diagnostic_imaging/imaging_modalities/dim_fluoroscopy/en/ Google Scholar
Linhart, M, Nielson, A, Andrié, R, et al. Fluoroscopy of spontaneous breathing is more sensitive than phrenic nerve stimulation for detection of right phrenic nerve injury during cryoballoon ablation of atrial fibrillation. J Cardiovasc Electr 2014; 25: 859–865.CrossRefGoogle ScholarPubMed
Lakhani, M, Saiful, F, Parikh, V, Goyal, N, Bekheit, S, Kowalski, M. Recordings of diaphragmatic electromyograms during cryoballoon ablation for atrial fibrillation accurately predict phrenic nerve injury. Heart Rhythm 2014; 11: 369–374.CrossRefGoogle ScholarPubMed
Haller, JA, Pickard, LR, Tepas, JJ, et al. Management of diaphragmatic paralysis in infants with special emphasis on selection of patients for operative plication. J Pediatr Surg 1979; 14: 779–785.CrossRefGoogle ScholarPubMed
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; 94: 383–388.CrossRefGoogle ScholarPubMed
Iverson, LI, Mittal, A, Dugan, DJ, Samson, PC. Injuries to the phrenic nerve resulting in diaphragmatic paralysis with special reference to stretch trauma. Am J Surg 1976; 132: 263–269.CrossRefGoogle Scholar
Aguirre, VJ, Sinha, P, Zimmet, A, Lee, GA, Kwa, L, Rosenfeldt, F. Phrenic nerve injury during cardiac surgery: mechanisms, management and prevention. Heart Lung Circ 2013; 22: 895–902.CrossRefGoogle ScholarPubMed
Kaufman, MR. Plication of the diaphragm: background, indications, contraindications [Internet]. Medscape 2020 [cited 2020 Dec 18], https://emedicine.medscape.com/article/1970326-overview,Google Scholar
Lemmer, J, Stiller, B, Heise, G, et al. Postoperative phrenic nerve palsy: early clinical implications and management. Intensive Care Med 2006; 32: 1227–1233.CrossRefGoogle ScholarPubMed
Schwartz, MZ, Filler, RM. Plication of the diaphragm for symptomatic phrenic nerve paralysis. J Pediatr Surg 1978; 13: 259–263.CrossRefGoogle ScholarPubMed
Ciccolella, DE, Daly, BD, Celli, BR. Improved diaphragmatic function after surgical plication for unilateral diaphragmatic paralysis. Am Rev Respir Dis 1992; 146: 797–799.CrossRefGoogle ScholarPubMed
Tönz, M, von Segesser, LK, Mihaljevic, T, Arbenz, U, Stauffer, UG, Turina, MI. Clinical implications of phrenic nerve injury after pediatric cardiac surgery. J Pediatr Surg 1996; 31: 1265–1267.CrossRefGoogle ScholarPubMed
Yellin, A, Lieberman, Y, Barzilay, Z. Postoperative unilateral diaphragmatic paralysis in children, a plea for early plication. Thorac Cardiovasc Surg 1991; 39: 221–223.CrossRefGoogle ScholarPubMed
Kizilcan, F, Tanyel, FC, Hiçsönmez, A, Büyükpamukçu, N. The long-term results of diaphragmatic plication. J Pediatr Surg 1993; 28: 42–44.CrossRefGoogle ScholarPubMed
Stauffer, UG, Rickham, PP. Acquired eventration of the diaphragm in the newborn. J Pediatr Surg 1972; 7: 635–640.CrossRefGoogle ScholarPubMed
Serraf, A, Planche, C, Lacour Gayet, F, Bruniaux, J, Nottin, R, Binet, JP. Post cardiac surgery phrenic nerve palsy in pediatric patients. Eur J Cardiothorac Surg 1990; 4: 421–424.CrossRefGoogle ScholarPubMed
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; 76: 297–304.CrossRefGoogle ScholarPubMed
Hamilton, JR, Tocewicz, K, Elliott, MJ, de Leval, M, Stark, J. Paralysed diaphragm after cardiac surgery in children: value of plication. Eur J Cardiothorac Surg 1990; 4: 487–491.CrossRefGoogle ScholarPubMed
Tsakiridis, K, Visouli, AN, Zarogoulidis, P, et al. Early hemi-diaphragmatic plication through a video assisted mini-thoracotomy in postcardiotomy phrenic nerve paresis. J Thorac Dis 2012; 4: 56–68.Google ScholarPubMed
Stamenovic, D. New technique of diaphragmatic plication by means of uniportal video-assisted thoracoscopic surgery. Interact Cardiovasc Thorac Surg 2017; 25: 162–163.CrossRefGoogle ScholarPubMed
Lewis, RJ, Caccavale, RJ, Sisler, GE, Mackenzie, JW. One hundred consecutive patients undergoing video-assisted thoracic operations. Ann Thorac Surg 1992; 54: 421–426.CrossRefGoogle ScholarPubMed
Mack, MJ, Aronoff, RJ, Acuff, TE, Douthit, MB, Bowman, RT, Ryan, WH. Present role of thoracoscopy in the diagnosis and treatment of diseases of the chest. Ann Thorac Surg 1992; 54: 403–409.CrossRefGoogle ScholarPubMed
Hines, MH. Video-assisted diaphragm plication in children. Ann Thorac Surg 2003; 76: 234–236.CrossRefGoogle ScholarPubMed
Seid, M, Varni, JW, Jacobs, JR. Pediatric health-related quality-of-life measurement technology: intersections between science, managed care, and clinical care. J Clin Psychol Med Settings 2000; 7: 17–27.CrossRefGoogle Scholar
Germain, N, Aballéa, S, Toumi, M. Measuring health-related quality of life in young children: how far have we come? J Mark Access Health Policy 2019; 7: 1618661.CrossRefGoogle ScholarPubMed
El Tantawy, AE, Imam, S, Shawky, H, Salah, T. Diaphragmatic nerve palsy after cardiac surgery in children in Egypt: outcome and debate in management. World J Pediatr Congenit Heart Surg 2013; 4: 19–23.CrossRefGoogle ScholarPubMed
Al-Ebrahim, KE, Elassal, AA, Eldib, OS, et al. Diaphragmatic palsy after cardiac surgery in adult and pediatric patients. Asian Cardiovasc Thorac Ann 2019; 27: 481–485.CrossRefGoogle ScholarPubMed
Smith, BM, Ezeokoli, NJ, Kipps, AK, Azakie, A, Meadows, JJ. Course, predictors of diaphragm recovery after phrenic nerve injury during pediatric cardiac surgery. Ann Thorac Surg 2013; 96: 938–942.CrossRefGoogle ScholarPubMed