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Ann Thorac Surg 1985;39:445-449
© 1985 The Society of Thoracic Surgeons

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Articles

Phrenic Nerve Injury Complicating Closed Cardiovascular Surgical Procedures for Congenital Heart Disease

From the Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, CA

Accepted for publication July 19, 1984.

^* Address reprint requests to Dr. Miller, Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, CA 94305

Phrenic nerve injury (PNI) with resulting hemidiaphragmatic paralysis occurred in 19 (2.1 ± 0.5%) of 891 closed cardiac surgical procedures during a twenty-three-year period. Diagnosis was confirmed by standard radiographic criteria. Phrenic nerve injury was most commonly noted following systemic-pulmonary artery anastomosis, ligation of persistent ductus arteriosus plus pulmonary artery banding, and atrial septectomy. Most patients were managed conservatively (nasotracheal or orotracheal intubation and positive end-expiratory pressure). Although no deaths were a direct result of PNI, major complications occurred in 15 of the 19 instances of PNI (79% ± 10%). The serious morbidity and the hospital costs associated with this complication, however, underscore the cardinal importance of prevention. If injury does occur, early surgical intervention (diaphragmatic plication) in very young infants may reduce the attendant morbidity, but the complete role of diaphragmatic plication remains to be defined.

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