Phrenic nerve injury following cardiac surgery: a review.
Phrenic nerve injury following cardiac surgery is variable in its incidence depending on the diligence with which it is sought. Definitive studies have shown this complication to be related to cold-induced injury during myocardial protection strategies and possibly to mechanical injury during internal mammary artery harvesting. The consequences are also variable and depend to a large extent on the underlying condition of the patient, particularly with regard to pulmonary function. The response of the patient may range from an asymptomatic radiographic abnormality to severe pulmonary dysfunction requiring prolonged mechanical ventilation and other associated morbidities and even mortality. Two cases are presented to demonstrate the variability in clinical responses to diaphragmatic dysfunction secondary to phrenic nerve injury from cardiac surgery. In addition, treatment strategies are reviewed including early tracheostomy and diaphragmatic plication, which appear to be the most effective options for patients who are compromised by phrenic injuries.
Tripp
H F
HF
Department of Cardiothoracic Surgery, Wilford Hall USAF Medical Center/MKSC 59th Medical Wing (AETC), Lackland Air Force Base, Texas 78236-5300, USA.
Bolton
J W
JW
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003964:Diaphragm / Q000294:innervation / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000293:injuries*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012133:Respiratory Paralysis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D014139:Tracheostomy