HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map 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): Craig J. Baker Brian L. Reemtsen Vaughn A. Starnes Winfield J. Wells Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Baker, C. J. Articles by Wells, W. J. Search for Related Content PubMed Articles by Baker, C. J. Articles by Wells, W. J.

J Thorac Cardiovasc Surg 2008;135:56-61
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Hemidiaphragm plication after repair of congenital heart defects in children: Quantitative return of diaphragm function over time

^a Department of Cardiothoracic Surgery, University of Southern California Keck School of Medicine, Los Angeles, Calif
^b Division of Cardiothoracic Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
^c Division of Cardiology, Children’s Hospital Los Angeles, Los Angeles, Calif.

Received for publication July 6, 2007; revisions received August 16, 2007; accepted for publication September 20, 2007.

^_* Address for reprints: Craig J. Baker, MD, Department of Cardiothoracic Surgery, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033. (Email: cbaker{at}surgery.usc.edu).

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.