title: Long-term management of diaphragmatic paralysis complicating prosthetic valve replacement.
abstract: The exact incidence of diaphragmatic paralysis complicating secondary heart procedures is not known. The postoperative period can be complicated by difficulty in weaning from mechanical ventilation and misinterpretation of the clinical signs of respiratory muscle fatigue for congestive heart failure and acute bronchospasm. We present 3 patients, all of whom had right diaphragmatic paralysis and recurrent respiratory failure after a second mitral valve replacement. Long-term management with night-time ventilation in 2 patients resulted in no further episodes of respiratory failure and physical rehabilitation with exercise tolerance significantly greater than the preoperative state.
mesh_terms: D000368:Aged; D005081:Exercise Therapy; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D012008:Recurrence; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012133:Respiratory Paralysis / Q000150:complications / Q000209:etiology / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods*