Clinical diagnosis and surgical treatment of diaphragmatic paralysis in infants with congenital heart disease after cardiac surgery

Objective To investigate the clinical manifestations, diagnosis and treatment of diagrammatic paralysis in infants with congenital heart disease (CHD) after cardiac surgery. Methods Thirty-one cases of diaphragmatic paralysis after cardiac surgery were selected from Jan.2006 to Jun.2012, including 23 cases were male and 8 cases were female.The age at operation was 20 days to 25 months, (8.0±5.5) months on the average.The body weight at operation was 3.1-12.2 kg, (6.8±2.3) kg on the average.All children received machine auxiliary breathing, and they had breathing difficulty without the machine.Diaphragmatic plication via 6-8 intercostal was performed under general anesthesia and endotracheal intubation.Lateral position, with uninjured side downward, was taken to perform chest posterolateral incision or chest lateral incision.Relaxing and weak diaphragm muscles were resected or directly sutured after folding.The clinical manifestations and diagnosis of children were summarized, and the effectiveness of diaphragmatic plication was evaluated. Results In 31 cases with diaphragmatic paralysis, there were 15 cases with left diaphragmatic paralysis, 12 cases with right diaphragmatic paralysis, and 4 cases with bilateral diaphragmatic paralysis.Thirty-one cases had dyspnea after weaning of ventilator, and 28 cases received reintubation, 23 cases with ventilator-associated pneumonia, and 10 cases with tracheotomy.Diaphragmatic plication was performed in 28 cases, and all of them were weaned off ventilator successfully after the placation.The time of preoperative mechanical ventilation lasted 119-827 hours[(447±225) hours], postoperative ventilator assistance time was 12-206 hours[(71±52) hours], which showed significant difference in time of ventilation(P<0.05). Conservative treatment was given to the remaining 3 cases, and they were weaned off ventilation successfully with a better recovery. Conclusions Diaphragmatic paralysis in infants after CHD surgery affects their recovery.Diaphragm plication is a safe and effective method to treat the diaphragm paralysis. Key words: Congenital heart disease; Diaphragmatic paralysis; Diaphragmatic plication