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Hemidiaphragm Plication after Repair of Congenital Heart Defects in Children; Quantitative Return of Diaphragm Function Over Time
C. J. Baker, V. Boulom, B. L. Reemtsen, R. C. Rollins, V. A. Starnes*, W. J. Wells*. Childrens Hospital Los Angeles, Los Angeles, CA,
BACKGROUND: Phrenic nerve injury with hemidiaphragm paresis leads to important morbidity in children undergoing repair of congenital heart defects (CHD). Previous studies have documented contributing factors and the short-term benefits of diaphragm plication, but little is known about return of diaphragm function.
METHODS: We performed a retrospective review of 46 consecutive patients undergoing hemidiaphragm plication following repair of CHD. The function of plicated diaphragms was measured at follow-up fluoroscopy using excursion of the contralateral unplicated side as a control.
RESULTS: Median age at the procedure resulting in phrenic nerve injury was 6.4 months (range 0-62 months). Among the 46 patients, 29 (63%) and 17 (37%) had repair for single ventricle and two-ventricle defects, respectively. Hemidiaphragm paresis occurred on the left in 32 (70%). Phrenic nerve injury was documented at a median of 8 days (1-84 d) after operation. Median time from diagnosis to plication was 2 days (0-21 d). Five patients needed prolonged ventilation after plication. One died 10 weeks later and 4 required tracheostomy. The remaining 41 patients were extubated within 2 days (0-19 d). In 17 patients, fluoroscopy to assess diaphragm motion was performed at a mean interval of 16.4 months after plication. Excursion of the plicated diaphragm was 77% of the contralateral normal side. There was a trend towards improved function over time.
CONCLUSIONS: Hemidiaphragm paresis results in important morbidity after repair of CHD. Early diagnosis and plication results in timely extubation. The plicated diaphragm shows a return of function that may improve over time. This is the first study to numerically quantitate the degree of diaphragm recovery.
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