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Management of phrenic nerve injury post-cardiac surgery in the paediatric patient

Part of: Surgery

Published online by Cambridge University Press:  26 July 2021

Abdulla Tarmahomed ,
Ahmed Adan ,
Ashvin Thomas ,
Ria Sanghavi ,
Kiran Amin ,
Waleed Asif ,
Ashleigh Pittams  and
Amer Harky Open the ORCID record for Amer Harky [Opens in a new window]
Abdulla Tarmahomed
Affiliation:
Department of Paediatric Cardiology, Alder Hey Children’s Hospital, Liverpool, UK
Ahmed Adan
Affiliation:
School of Medicine, University of Liverpool, LiverpoolL69 3GE, UK
Ashvin Thomas
Affiliation:
Faculty of Medicine, Imperial College London, LondonSW7 2AZ, UK
Ria Sanghavi
Affiliation:
School of Medicine, University of Central Lancashire, PrestonPR1 7BH, UK
Kiran Amin
Affiliation:
St George’s University of London, LondonSW17 0RE, UK
Waleed Asif
Affiliation:
School of Medicine, University of Liverpool, LiverpoolL69 3GE, UK
Ashleigh Pittams
Affiliation:
Royal Sussex County Hospital, BrightonBN2 5BE, UK
Amer Harky*
Affiliation:
Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, LiverpoolL14 3PE, UK Department of Paediatric Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK
*
Author for correspondence: Amer Harky, MBChB, MRCS, MSc, Liverpool Heart and Chest Hospital, Thomas drive, LiverpoolL14 3PE, UK. Tel: +44 151 600 1616. E-mail: amer.harky@lhch.nhs.uk
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Abstract

Background:

Phrenic nerve injury is a common complication of cardiac and thoracic surgical procedures, with potentially severe effects on the health of a child. This review aims to summarise the available literature on the diagnosis and management of PNI post-cardiac surgery in paediatric patients with CHD.

Main body:

The presence of injury post-surgery can be difficult to detect and may present with non-specific symptoms, emphasising the importance of an effective diagnostic strategy. Chest X-ray is usually the first investigation for a suspected diagnosis of PNI, which is usually confirmed using fluoroscopy, ultrasound scan, or phrenic nerve stimulation (gold standard). Management options include supportive ventilation and/or invasive diaphragmatic plication surgery. While the optimal timing of plication surgery remains controversial, it is now the most widely accepted treatment for PNI in children post-CHD surgery, especially for very young patients who cannot be weaned off supportive ventilation. Further research is needed to determine the optimal timing of surgical intervention for positive outcomes and to explore the benefits of using minimally invasive surgical techniques in children.

Conclusion:

PNI is a common and serious complication of CHD surgery, therefore, its diagnosis and management in the paediatric population are of major importance. Further research is needed to determine the optimal timing of surgical intervention for positive outcomes and to explore the benefits of using minimally invasive surgical techniques in children.

Keywords

Phrenic nervecardiac surgery
Type
Review
Information
Cardiology in the Young , Volume 31 , Issue 9 , September 2021 , pp. 1386 - 1392
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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