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Ann Thorac Surg 2004;78:1517-1518
© 2004 The Society of Thoracic Surgeons

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Correspondence

Reply

Department of Cardiothoracic Surgery, The Second Teaching Hospital of Shanxi Medical University, 382 Wuyilu, Taiyuan, Shanxi, 030001, China

dengyongzhi{at}hotmail.com

To the Editor:

We thank Dr Canbaz and colleagues for their comments and for noting the typographical error in our paper [1]. They have mentioned their experience with phrenic nerve injury associated with the use of ice slush. In accordance with the recommendation of Dimopoulo and colleagues [2], no ice slush nor other topical cooling agents were used in our series, thus precluding cold injury as a cause.

It is acknowledged that the electromyogram (EMG) findings are likely to be similar between cold injury and direct trauma [3]. Despite this, it is not appropriate to extrapolate the EMG findings associated with left phrenic neuropraxia to those on the right, as the anatomy, blood supply and EMG results are all dissimilar [3]. The question is whether or not the EMG will provide useful information beyond that provided by our investigations. Does it predict recovery of a paralysed right diaphragm? There does not appear to be any evidence so far that this is the case, and the prediction of recovery remains a difficult problem. Does it predict failure of recovery? In the experience of Dr Canbaz and colleagues the answer is clearly no.

The EMG is however clearly a very useful investigation when a chest roentgenogram is not diagnostic, particularly when there is difficulty weaning from mechanical ventilation or when pleural effusions obscure the level of the diaphragm.

References

1. Deng Y, Byth K, Paterson HS. Phrenic nerve injury associated with high free right internal mammary artery harvesting. Ann Thorac Surg. 2003;76:459–463[Abstract/Free Full Text]
2. Dimopoulo I, Daganou M, Dafni U, et al. Phrenic nerve dysfunction after cardiac operations. Chest. 1998;113:8–14[Abstract/Free Full Text]
3. Chroni E, Patel RL, Taub N, Venn GE, Howard RS, Panayiotopoulos CP. A comprehensive electrophysiological evaluation of phrenic nerve injury related to open-heart surgery. Acta Neurol Scand. 1995;91:255–259[Medline]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hugh S. Paterson Yongzhi Deng Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Paterson, H. S. Articles by Byth, K. Search for Related Content PubMed Articles by Paterson, H. S. Articles by Byth, K. Related Collections Coronary disease Related Article