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  • Meeting abstract
  • Open Access

Surgery of diaphragm paralysis in patient with severe dyspnea after coronary artery bypass grafting with aortic valve replacement

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Journal of Cardiothoracic Surgery201510 (Suppl 1) :A52

https://doi.org/10.1186/1749-8090-10-S1-A52

  • Published:

Keywords

  • Coronary Artery Bypass
  • Aortic Valve Replacement
  • Respiratory Muscle
  • Phrenic Nerve
  • Muscle Training

Background/Introduction

Unilateral diaphragm paralysis is an often not recognized cause of dyspnea especially after cardiac surgery procedures. In some cases diaphragm paralysis disables to wean patient from ventilation. Surgical treatment of unilateral diaphragm paralysis has been described in case reports and in small series since 1985.

Aims/Objectives

We present a 56-years-old female with left phrenic nerve paralysis after coronary artery bypass grafting with aortic valve replacement.

Method

The patient was extubated in 6 hours after the operation. During next two days progressive dyspnea was observed and patient became ventilation dependent. Six attempts to wean patient from ventilator failed. Elevation of diaphragm up to the 3rd rib have been registered. Since there was no improvement after respiratory muscle training, plication of the hemidiaphragm was performed by a left thoracotomy.

Results

The patient improved with regard to respiratory complaints and lung function. Extubation have been performed in 12 hours after diaphragm plication. In 3 days patient was transferred from ICU and later on discharged from the hospital free from dyspnea, angina and heart insufficiency. Their quality of life is greatly improved. The patient is now in follow up for 4 months.

Discussion/Conclusion

The success of surgical treatment depends on preoperative selection of patients. It is necessary to exclude all other reasons responsible to dyspnea. Although comparison of the available data of diaphragm plication seems an effective and safe procedure for patients with symptomatic, acquired unilateral diaphragm paralysis.

Consent

Authors’ Affiliations

(1)
Federal Centre for Cardiovascular Surgery, Astrakhan, 414024, Russia

Copyright

© Tungusov et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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