HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by O'Brien, J. W. Articles by Smith, P. K. Search for Related Content PubMed PubMed Citation Articles by O'Brien, J. W. Articles by Smith, P. K.

The Annals of Thoracic Surgery, Vol 52, 182-188, Copyright © 1991 by The Society of Thoracic Surgeons

ARTICLES

Effects of internal mammary artery dissection on phrenic nerve perfusion and function

JW O'Brien, SH Johnson, SJ VanSteyn, DM Craig, RE Sharpe, MC Mauney and PK Smith
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.

The effects of left internal mammary artery (LIMA) dissection and distal division on phrenic nerve perfusion and function were examined in an adult swine model. Phrenic nerve perfusion was determined by left atrial injection of radioactively labeled microspheres. Phrenic nerve function was determined by measuring nerve and diaphragm potentials evoked by bilateral phrenic nerve stimulation. In the first group of animals (n = 9), the LIMA was dissected with ligation of all its branches. Left phrenic nerve perfusion and function decreased after LIMA dissection in every animal studied, whereas only minimal changes were observed on the right. Sixty minutes after LIMA dissection, left phrenic nerve mean perfusion decreased 71%. Left phrenic nerve and left diaphragm mean action potential amplitudes decreased 54% and 80%, respectively. In the second group of animals (n = 4), the LIMA dissection was performed without division of the pericardiacophrenic artery, a small proximal branch of the internal mammary artery that supplies the phrenic nerve. Sixty minutes after LIMA dissection, left phrenic nerve perfusion had decreased by 21% from control values, with a corresponding decrease in left phrenic nerve and diaphragm mean action potential amplitudes of 19% and 23%, respectively. These results indicate that LIMA dissection with division of all its branches in this model is associated with a significant impairment in left phrenic nerve perfusion and function and suggests a causal relationship. These results may also explain the apparent increased phrenic nerve cold sensitivity and increased incidence of phrenic nerve dysfunction associated with LIMA grafting.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				M. Loukas, C. R. Kinsella Jr, R. G. Louis Jr, S. Gandhi, and B. Curry Surgical Anatomy of the Accessory Phrenic Nerve Ann. Thorac. Surg., November 1, 2006; 82(5): 1870 - 1875. [Abstract] [Full Text] [PDF]

				M. A. Merino-Ramirez, G. Juan, M. Ramon, J. Cortijo, E. Rubio, A. Montero, and E. J. Morcillo Electrophysiologic evaluation of phrenic nerve and diaphragm function after coronary bypass surgery: Prospective study of diabetes and other risk factors. J. Thorac. Cardiovasc. Surg., September 1, 2006; 132(3): 530 - 536.e2. [Abstract] [Full Text] [PDF]

				L. Yazicioglu, A. Aral, O. Uymaz, and H. Akalin Coronary Artery Bypass Surgery in A Patient with a Functional Single Lung Asian Cardiovasc Thorac Ann, December 1, 2005; 13(4): 377 - 379. [Abstract] [Full Text] [PDF]

				H. P. Grocott, J. A. Clark, H. M. Homi, and A. Sharma "Other" Neurologic Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 213 - 226. [Abstract] [PDF]

				Y. Deng, K. Byth, and H. S. Paterson Phrenic nerve injury associated with high free right internal mammary artery harvesting Ann. Thorac. Surg., August 1, 2003; 76(2): 459 - 463. [Abstract] [Full Text] [PDF]

				E. D. Sivak Liberation From Mechanical Ventilation Following Heart Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2002; 6(3): 203 - 217. [Abstract] [PDF]

				A. D. Sharma, C. L. Parmley, G. Sreeram, and H. P. Grocott Peripheral Nerve Injuries During Cardiac Surgery: Risk Factors, Diagnosis, Prognosis, and Prevention Anesth. Analg., December 1, 2000; 91(6): 1358 - 1369. [Full Text] [PDF]

				S. A. Chapman, M. D. Holmes, and D. J. Taylor Unilateral Diaphragmatic Paralysis Following Bronchial Artery Embolization for Hemoptysis Chest, July 1, 2000; 118(1): 269 - 270. [Abstract] [Full Text] [PDF]

				N M Siafakas, I Mitrouska, D Bouros, and D Georgopoulos Surgery and the respiratory muscles Thorax, May 1, 1999; 54(5): 458 - 465. [Full Text]

				A. J. Cohen, M. G. Katz, R. Katz, D. Mayerfeld, E. Hauptman, and A. Schachner Phrenic Nerve Injury After Coronary Artery Grafting: Is It Always Benign? Ann. Thorac. Surg., July 1, 1997; 64(1): 148 - 153. [Abstract] [Full Text]

				J. B. Choi and S. Y. Lee Skeletonized and Pedicled Internal Thoracic Artery Grafts: Effect on Free Flow During Bypass Ann. Thorac. Surg., March 1, 1996; 61(3): 909 - 913. [Abstract] [Full Text]

				M. Nasu, T. Akasaka, T. Okazaki, M. Shinkai, H. Fujiwara, J. Sono, Y. Okada, S. Miyamoto, S. Nishiuchi, J. Yoshikawa, et al. Postoperative Flow Characteristics of Left Internal Thoracic Artery Grafts Ann. Thorac. Surg., January 1, 1995; 59(1): 154 - 162. [Abstract] [Full Text]