Phrenic nerve paralysis following pediatric cardiac surgery. Role of diaphragmatic plication.

Eighteen children sustained unilateral phrenic nerve paralysis (PNP) after cardiac surgical procedures. Ten (Group I), under 7 months (mean: 2.9 +/- 2.2), required long-term ventilatory assistance (mean: 23.9 +/- 13.0 days); they failed to be weaned from the ventilator. All underwent diaphragmatic plication (DP). DP was performed late in 7 cases (Group Ia) with a mean time of 30.8 days between surgery and DP, and early in 3 others (Group Ib) with a mean time of 10.2 days. Eight children (Group II), older than 1 year, tolerated PNP better and could be extubated early without diaphragmatic plication. In Group Ia severe lung infections were recorded in 5 before or/and after DP, and two died at 3 and 30 days after plication. Five children from Group Ia and all 3 from Group Ib were late survivors. They could be weaned from ventilatory support in a mean time of 3 days after DP, although those with severe lung infection (Group Ia) took the longest time. All from Group II were late survivors. We conclude: PNP is well tolerated without plication in children older than 1 year. However early DP offers excellent and immediate results in infants with PNP. Early DP in these children avoids or reduces severe lung infections and death.

Aortopulmonary window with anomalous origin of the right coronary artery from the pulmonary trunk.

A case of aortopulmonary window associated with an anomalous origin of the right coronary artery from the pulmonary artery in a 3-month-old boy is reported. Angiographic diagnosis could be difficult because of the simultaneous filling of both great arteries that obscure the origin of the anomalous vessel; however, a careful evaluation of the angiogram may contribute to an accurate diagnosis. The surgical correction of this association of defects requires the connection of the aorta with the anomalous coronary ostium. An intrapulmonary tunneling procedure by means of a baffle is described.