ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
, Ahmet Şükrü MERCAN, Nazan BİTİR, Atilla SEZGİN, Birgül VARAN, Sait AŞLAMACI, * Arda SAYGILI, * Kürşad TOKEL
Başkent Üniversitesi Kalp Damar Cerrahisi Ana Bilim Dalı, Ankara
*Başkent Üniversitesi Pediatrik Kardiyoloji Bölümü, Ankara
Background: Diaphragmatic paralysis in congenital heart surgery plays an important role for both morbidity and mortality especially during early postoperative period. In this study we evaluated our patients for phrenic nerve injury during early postoperative period, and we revised our clinical protocol for its management.

Methods: In 2000, 335 patients underwent operation for congenital heart defects. The mean age of the patients were 3.95 ± 7.22 years (3 days - 57 years). In 10 cases (2.9%), phrenic nerve injury was diagnosed. The mean age of these patients was 3.04 ± 2 years (4 months - 6 years), 5 (50%) patients were under the age of 2 years and 3 (30%) patients were in infancy period. Paralysis was bilateral in 3 patients.

Results: Diaphragmatic plication was applied in 6 patients (60%), the time interval between the first operation and the plication was 16.4 ± 15.07 days. One patient died who had bilateral plication due to cardiac problem, the rest of the patients were free of symptoms 3 months after their discharge. Four patients were taken to medical management, one of them was died due to unexpected respiratory arrest during hospitalization, other 3 patients were free of symptoms after 3 months of their discharge.

Conclusions: Age is important for the indication of diapragmatic plication due to smaller respiratory reserve of the infants but patients in older ages are also under the high risk for both mortality and morbidity. Therefore plication should be applied before the occurrence of respiratory problems.

Keywords : Diaphragma, paralysis, plication, phrenic nerve injury
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