Phrenic palsy after pediatric cardiac surgery: what is the best modality of management?

Abstract

Background: Pediatric cardiac surgery is one of the most common causes of diaphragmatic palsy (DP) in infants and young children. The main target in managing a patient with DP is to preserve the respiratory function. Surgical diaphragmatic plication is widely used surgical treatment of DP nowadays especially in infants than in young children. Tracheostomy was suggested also to facilitate the suction of the chest and decrease the pulmonary complications. Thus, the aim of this study was to detect the effect of early intervention to correct the phrenic palsy either by diaphragmatic plication, Tracheostomy or both in pediatric cardiac surgery patients.
 Methods: This is a retrospective study on pediatric patients who had cardiac surgical procedures between June 2008 and Dec 2018. There were 3706 patients had been operated at different age groups of whom 42 patients developed DP. The patients were divided into four groups according to type of treatment: Group A for conservative treatment, Group B for diaphragmatic plication only, Group C for tracheostomy only, and Group D for tracheostomy and plication.
 Results: The mean age of the studied group was 19.7 ±23 . There was male predominance (78.6 %). Timing of tracheostomy in days was as 30 ±7.1, and 31.8 ±5.4 in group C, and D respectively. Timing of plication was as 10 ±8.3, and 11.1 ±7.6 in group B, and D consequence 
 Conclusion: The least sepsis recorded for patients with both tracheostomy and DP, delayed surgical intervention led to higher mortality and more sepsis recorded as in conservative technique.