What are the possible complications of diaphragmatic paralysis?

Updated: Oct 10, 2018
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Phrenic nerve injury commonly occurs from cold cardioplegia or mechanical stretching during open-heart surgery.

Diaphragmatic dysfunction often occurs postoperatively in patients undergoing cardiac surgery. This has been attributed to pleurotomy in order to harvest internal mammary artery (IMA) grafts, which results in greater chest wall and parenchymal trauma, greater pain, and impairment of cough and deep breathing. In addition, IMA dissection may reduce blood supply to ipsilateral intercostal muscles and may cause mechanical injury to the phrenic nerve.

In the past, studies have confirmed phrenic nerve injury from cold-induced injury during myocardial protection, although in current practice most centers use warm cardioplegia.

The consequences of post–cardiac surgery diaphragm dysfunction vary from asymptomatic radiographic abnormalities to severe pulmonary dysfunction requiring prolonged mechanical ventilation and increased morbidity and mortality.

In one study, the incidence of diaphragmatic dysfunction was 11% (5 of 44 patients). But only one patient had phrenic nerve palsy.

Most patients with post–cardiac surgery diaphragmatic dysfunction improve with conservative measures such as chest physiotherapy, prevention and treatment of pneumonia, treatment of underlying chronic obstructive pulmonary disease (if present), and overall care. Rarely, diaphragmatic plication may also be required in such patients.

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