Diaphragm Dysfunction After Cardiac Surgery

Q: After Cardiothoracic surgery, which side of the diaphragm tends to have paralysis? - select one

A) left

B) right

Answer: A

During cardiothoracic surgery, stretching or cooling may cause phrenic nerve injury, resulting in unilateral diaphragmatic paralysis. The literature has described a wide range of occurrences, from 1.3 to 60 percent. Most are clinically not significant. 

This is because the Left Internal Mammary Artery (LIMA) is most often used in the bypass. Use of RIMA can cause similar pathology on the right side. 

Recovery may take up to one to two years.

#surgical-critical-care

#neurology

References:

1. Katz MG, Katz R, Schachner A, Cohen AJ. Phrenic nerve injury after coronary artery bypass grafting: will it go away? Ann Thorac Surg 1998; 65:32.

2. Canbaz S, Turgut N, Halici U, et al. Electrophysiological evaluation of phrenic nerve injury during cardiac surgery--a prospective, controlled, clinical study. BMC Surg 2004; 4:2.

3. Laghlam D, Lê MP, Srour A, Monsonego R, Estagnasié P, Brusset A, Squara P. Diaphragm Dysfunction After Cardiac Surgery: Reappraisal. J Cardiothorac Vasc Anesth. 2021 Nov;35(11):3241-3247. doi: 10.1053/j.jvca.2021.02.023. Epub 2021 Feb 11. PMID: 33736912.