Patient selection: child with congenital heart disease undergoing cardiac surgery
Outcome: diaphragmatic paralysis
Causes of phrenic nerve damage:
(1) transection or resection
(2) crush injury
(3) stretch injury
(4) thermal injury (hyper or hypothermia)
Presentations may include:
(1) difficulty weaning after surgery
(2) recurrent respiratory distress
(3) recurrent pneumonia
(4) atelectasis of lower lobe
Risk factors for post-operative diaphragmatic paralysis:
(1) older age in months (mean 41 months +/- 28)
(2) lower weight in kilograms (mean 7.1 kg)
(3) cyanotic heart disease
(4) history of previous cardiac surgery
Procedures associated with diaphragmatic paralysis:
(1) Fontan procedure
(2) Blalock-Taussig shunt surgery
(3) arterial switch operation
