title: Hemidiaphragm plication after repair of congenital heart defects in children: quantitative return of diaphragm function over time.
abstract: OBJECTIVE
  Phrenic nerve injury resulting in hemidiaphragm paresis leads to morbidity in children undergoing repair of congenital heart defects. Previous studies have documented short-term benefits of diaphragm plication, but little is known about the return of diaphragm function.
  
  
  METHODS
  We reviewed 46 consecutive patients undergoing hemidiaphragm plication after repair of congenital heart defects. The function of plicated diaphragms was measured at follow-up fluoroscopy using excursion of the unplicated side as a control.
  
  
  RESULTS
  The median age at the procedure resulting in phrenic nerve injury was 6.4 months (0-62 months). Among the 46 patients, 29 (63%) and 17 (37%) had repair for single and 2-ventricle defects, respectively. Hemidiaphragm paresis occurred on the left side in 32 patients (70%). Phrenic nerve injury was documented at a median of 8 days (1-84 days) after operation. The median time from diagnosis to plication was 2 days (0-21 days). Five patients required prolonged ventilation after plication. One patient died 10 weeks later, and 4 patients required tracheostomy. The remaining 41 patients were extubated within 2 days (0-19 days). In 17 patients, fluoroscopy assessing diaphragm motion was performed at a mean interval of 16.4 months after plication. Excursion of the plicated diaphragm was 77% of the contralateral side. There was a trend toward improved function over time.
  
  
  CONCLUSIONS
  Hemidiaphragm paresis results in significant morbidity after repair of congenital heart defects. Early diagnosis and plication result in timely extubation. The plicated diaphragm demonstrates return of function that may improve over time. This is the first study to numerically quantitate the degree of diaphragm recovery.
authors.affiliation: Department of Cardiothoracic Surgery, University of Southern California Keck School of Medicine, Los Angeles, Calif 90033, USA. cbaker@surgery.usc.edu
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Baker
authors.forename: Valy
authors.initials: V
authors.lastname: Boulom
authors.forename: Brian L
authors.initials: BL
authors.lastname: Reemtsen
authors.forename: Robert C
authors.initials: RC
authors.lastname: Rollins
authors.forename: Vaughn A
authors.initials: VA
authors.lastname: Starnes
authors.forename: Winfield J
authors.initials: WJ
authors.lastname: Wells
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003964:Diaphragm / Q000503:physiopathology*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010791:Phrenic Nerve / Q000293:injuries; D020127:Recovery of Function; D012133:Respiratory Paralysis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome