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J Thorac Cardiovasc Surg 2003;125:1158-1159
© 2003 The American Association for Thoracic Surgery

Brief Communications

Bilateral diaphragmatic paralysis after aortic surgery with topical hypothermia: Ventilatory assistance by means of nasal mask bilevel positive pressure

Yoshiyuki Tokuda, MD, Masahiko Matsumoto, MD, Takaaki Sugita, MD, Junichiro Nishizawa, MD, Katsuhiko Matsuyama, MD, Kazunori Yoshida, MD, Takehiko Matsuo, MD Nara, Japan

From the Departments of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.

Received for publication Aug 28, 2002. Accepted for publication Sept 9, 2002. Address for reprints: Yoshiyuki Tokuda, MD, Department of Cardiovascular Surgery, Tenri Hospital, 200 Mishima, Tenri, 632-8552, Japan (E-mail: tokuda@mxb.mesh.ne.jp).

The first 20% of the full text of this article appears below.

Bilateral diaphragmatic paralysis is a rare but severe complication of cardiac surgery mainly caused by hypothermic injury of phrenic nerves.Go Go 1,2 Most patients with bilateral diaphragmatic paralysis have been treated with positive-pressure ventilators through tracheostomy.Go 3 Recently, noninvasive positive airway ventilation has been applied to various types of respiratory failure. We report the case of a 35-year-old man who had postoperative bilateral diaphragmatic paralysis and was treated with nasal mask bilevel positive airway pressure (BiPAP) ventilation.

Clinical summary

A 35-year-old man with a history of renal dysfunction and hypertension complained of sudden chest pain and was referred to our hospital. Computed tomography revealed the presence of Stanford type A acute aortic dissection and a large amount of pericardial effusion. The patient was in shock because of cardiac tamponade.

The patient underwent an emergency operation. During the operation, cardiopulmonary bypass was established with right atrial venous cannulation and left femoral arterial cannulation. The patient was cooled to 25°C by using the cardiopulmonary bypass circuit. The dilated ascending aorta was . . . [Full Text of this Article]






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