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

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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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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.
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10.	王顺民, 徐志伟, 苏肇伉, 等. 先天性心脏病矫治术后膈肌麻痹的诊断与治疗. 中国胸心血管外科临床杂志, 2009, 16(2): 144-145.

1. 张燕搏, 王旭, 李守军, 等. 儿童先天性心脏病术后膈肌麻痹的临床研究. 中华实用诊断与治疗杂志, 2011, 25(12): 1152-1153.
2. 张燕搏, 王飞燕, 王强, 等. 儿童心脏外科重症监护病房医院感染临床研究. 中华实用诊断与治疗杂志, 2011, 25(5): 429-432.
3. 丁楠, 舒强, 李晓峰, 等. 婴儿先天性心脏病术后膈肌麻痹的外科治疗. 中国胸心血管外科临床杂志, 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. 王顺民, 徐志伟, 苏肇伉, 等. 先天性心脏病矫治术后膈肌麻痹的诊断与治疗. 中国胸心血管外科临床杂志, 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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