The Annals of Thoracic Surgery, Vol 32, 250-259, Copyright © 1981 by The Society of Thoracic Surgeons
Aggressive treatment of acquired phrenic nerve paralysis in infants and small children
R Shoemaker, G Palmer, JW Brown and H King
Transthoracic diaphragmatic plication is a simple and effective means of
treatment for phrenic nerve injury and resultant diaphragmatic paralysis,
and should be undertaken as soon as the diagnosis of diaphragmatic
paralysis is established in a child with substantial respiratory
difficulty. Seven of more than 1,500 patients sustained phrenic nerve
injury during operation for congenital heart disease at our institution
over the past five years. All but 1 patient were less than 5 months old,
and the average weight was 3.8 kg. Five of the 7 could not be weaned from
the ventilator, and the other 2 had persistent postoperative tachypnea and
stridor. Before 1980, 3 patients were intubated for an average of 16 days
prior to diagnosis by fluoroscopy. Since then, 4 patients have been
intubated for an average of 7.8 days before diagnosis. All 7 underwent
transthoracic diaphragmatic plication and were extubated by 6 days after
operation (mean, 3.7 days). Six patients survived and are doing well. The 1
death occurred in 1976 in a premature infant with multiple congenital
cardiac lesions; diagnosis was delayed until the twenty-eighth day after
intubation and transthoracic diaphragmatic plication, until the
sixty-second day. This infant died of pneumonia one month after extubation.
These data support our policy of establishing an early diagnosis of phrenic
nerve injury and early treatment utilizing transthoracic diaphragmatic
plication in symptomatic children.
