Abstract 16575: Diaphragmatic Dysfunction After Repair of Congenital Heart Defects: Return of Diaphragm Function Occurs in a Significant Proportion of Patients
Objective: Hemi-diaphragm dysfunction from phrenic nerve injury is a known complication of congenital cardiac surgery. Return of diaphragm function can occur; however, most estimates of its prevalence emanate from historic literature and no analysis exists examining factors predicting recovery. We sought to document the course of diaphragmatic function after phrenic nerve injury in the current era, with a focus on factors predicting return of function.
Methods: Records were reviewed for all cases of post-operative diaphragmatic dysfunction following congenital cardiac surgery at this institution between 1991 and 2010. Follow up ultrasound and fluoroscopic studies were reviewed for return of diaphragm function.
Results: 72 cases of post-operative hemi-diaphragm dysfunction were identified. 40 cases were plicated prior to discharge. Plicated patients were younger at time of diagnosis (median 46 vs. 116 days p = 0.025) and had a larger proportion of single ventricle diagnoses (35% vs. 12.5%) compared to non-plicated patients. 23 patients with dysfunction were excluded in follow-up due to lack of studies documenting diaphragm function after the diagnostic study. Cases lost to follow-up were less likely to have a single ventricle diagnosis (5% vs 43% of those included). Of the remaining 49 cases, median time of follow-up was 353 days (range: 6 days to 17 years) and median time to documented recovery was 278 days (range: 12 days -17 years). The proportion of recovery was similar between plicated and unplicated patients (60.6% and 59.3% respectively). Patients who sustained diaphram dysfunction after Glenn were at higher risk to fail recovery compared to those undergoing Norwood (OR 4.50 but statistical significance was not observed due to due to small numbers (p = 0.1). RACHS1 score, age at diagnosis and side of paralysis did not predict failure of recovery.
Conclusion: In the current era, return of diaphragm function is common following phrenic nerve injury sustained during congenital cardiac surgery, and may occur late. There are no conclusive factors predicting diaphragmatic recovery. Prospective studies are required to accurately assess the course and clinical significance of diaphragmatic function, particularly in those with univentricular hearts.
- © 2011 by American Heart Association, Inc.