Clinical efficacy of diaphragmatic plication in the treatment of diaphragmatic paralysis after congenital heart defect operation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHENG Lin , ZHOU Yuzi , WANG Peng , LI Shengli ,  WANG Xu

Department of PICU, Pediatric Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding?author：

WANG Xu, Email: fwpicu@163.com

Keywords：

Congenital heart disease; diaphragmatic paralysis; diaphragmatic plication

DOI：

10.7507/1007-4848.202003003

Video：

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Objective To investigate the timing and clinical efficacy of diaphragmatic plication in the treatment of diaphragmatic paralysis after congenital heart disease (CHD) operation.Methods From January 2013 to February 2019, 30 children with CHD who were treated in Fuwai Hospital were collected, including 17 males and 13 females with a median age of 19.5 (3, 72) months. There were 6 patients with bilateral diaphragmatic paralysis (bilateral group) and 24 patients with unilateral diaphragmatic paralysis (unilateral group). The clinical data of the two groups were compared.Results Among the 6 bilateral diaphragmatic paralysis patients, 2 underwent bilateral diaphragmatic plication, and the other 4 patients continued their off-line exercise after unilateral diaphragmatic plication. Patients in the unilateral group had shorter ventilator use time (266.77±338.34 h vs. 995.33±622.29 h, P=0.001) and total ICU stay time (33.21±23.97 d vs. 67.33±28.54 d, P=0.008) than those in the bilateral group. One patient died in the bilateral group, and there was no statistical difference between the two groups (P=0.363). There was no statistical difference in the ICU stay time after diaphragm plication between the two groups (11.68±10.28 d vs. 29.83±27.73 d, P>0.05).Conclusion Diaphragmatic plication is an effective treatment for diaphragmatic paralysis after CHD operation once the conservative treatment failed. The prognosis of bilateral diaphragmatic paralysis is worse than that of unilateral diaphragmatic paralysis. Strict control of indications for surgery is beneficial to the early recovery of patients.

Citation： ZHENG Lin, ZHOU Yuzi, WANG Peng, LI Shengli, WANG Xu. Clinical efficacy of diaphragmatic plication in the treatment of diaphragmatic paralysis after congenital heart defect operation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1303-1306. doi: 10.7507/1007-4848.202003003 Copy

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9.	Dagan O, Nimri R, Katz Y, et al. Bilateral diaphragm paralysis following cardiac surgery in children: 10-years' experience. Intensive Care Med, 2006, 32(8): 1222-1226.
10.	王順民, 徐志偉, 蘇肇伉, 等. 先天性心臟病矯治術后膈肌麻痹的診斷與治療. 中國胸心血管外科臨床雜志, 2009, 16(2): 144-145.

1. 張燕搏, 王旭, 李守軍, 等. 兒童先天性心臟病術后膈肌麻痹的臨床研究. 中華實用診斷與治療雜志, 2011, 25(12): 1152-1153.
2. 張燕搏, 王飛燕, 王強, 等. 兒童心臟外科重癥監護病房醫院感染臨床研究. 中華實用診斷與治療雜志, 2011, 25(5): 429-432.
3. 丁楠, 舒強, 李曉峰, 等. 嬰兒先天性心臟病術后膈肌麻痹的外科治療. 中國胸心血管外科臨床雜志, 2016, 23(8): 792-795.
4. Joho-Arreola AL, Bauersfeld U, Staufer UG, et al. Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children. Eur J Cardiothorac Surg, 2005, 27(1): 53-57.
5. Akay TH, Ozkan S, Guhekin B, et al. Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management. Pediatr Surg Int, 2006, 22(4): 341-346.
6. Baker CJ, Boulom V, Reemtsen BL, et al. Hemidiaphragm plication after repair of congenital heart defects in children; quantitative return of diaphragm function over time. J Thorac Cardiovasc Surg, 2008, 135(1): 56-61.
7. Jog SM, Patole SK. Diaphragmatic paralysis in extremely low birth weight neonates: Is waiting for spontaneous recovery justified. J Pediatric Child Health, 2002, 38(1): 101-103.
8. Bhaskar P, Lone RA, Sallehuddin A, et al. Bilateral diaphragmatic palsy after congenital heart surgery: management options. Cardiol Young, 2016, 26(5): 927-930.
9. Dagan O, Nimri R, Katz Y, et al. Bilateral diaphragm paralysis following cardiac surgery in children: 10-years' experience. Intensive Care Med, 2006, 32(8): 1222-1226.
10. 王順民, 徐志偉, 蘇肇伉, 等. 先天性心臟病矯治術后膈肌麻痹的診斷與治療. 中國胸心血管外科臨床雜志, 2009, 16(2): 144-145.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of diaphragmatic plication in the treatment of diaphragmatic paralysis after congenital heart defect operation

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