Diaphragmatic dysfunction commonly occurs postoperatively in patients post cardiac surgery. Phrenic nerve injury may occurs from cold cardioplegia or mechanical stretching during open-heart surgery. It has also been attributed to pleurotomy in order to harvest internal mammary artery (IMA) grafts. IMA dissection may reduce blood supply to ipsilateral intercostal muscles and may cause mechanical injury to the phrenic nerve. Previously, phrenic nerve injury was mostly blamed from cold-induced injury, though now warm cardioplegia is a regular practice. Most patients with post–cardiac surgery diaphragmatic dysfunction improve with conservative measures such as chest physiotherapy. Also, patients develop compensatory mechanisms. The definitive surgical option is plication of diaphragm. Off-pump CABGs said to reduce the incidences.
References:
Yatin Mehta, Mayank Vats, Ajmer Singh, and Naresh Trehan - Incidence and management of diaphragmatic palsy in patients after cardiac surgery - Indian J Crit Care Med. 2008 Jul-Sep; 12(3): 91–95.
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