| Abstract
| - From January 1978 to December 1988, 109 phrenic nerve paralyses (PNP)occurred in a total of 9149 cardiac operations performed in a population ofpatients younger than 15 years old (1.2%) whose age varied from 1 day to 15years old and mean weight was 11.3 +/- 8.7 kg. PNP was diagnosed in 43patients after closed procedures (1.2% of 3509 procedures) and in 66patients after open heart operations (1.2% of 5640 operations). PNP wasright sided in 49 cases and left sided in 60 cases. Open heart operationsthat predisposed to PNP were those which needed harvesting of autologouspericardium (P less than 0.0001) and wide exposure of the great vessels.The modified right Blalock-Taussig shunt was the main cause of PNP inclosed procedures (P less than 0.02). Small children tolerated PNP lesswell. They needed longer ventilatory support (P less than 0.0005) anddeveloped more respiratory complications. Seventeen children underwentplication of the affected hemidiaphragm and could be subsequentlyextubated. It is concluded that for prevention of PNP, a high level ofattention should be exercised in neonates and small children, particularlywhen pericardium is harvested or when exposure needs extensive dissectionof the great vessels and thymus resection, or at reoperation. We alsoprefer to avoid the use of iced slush lavage. PNP, when symptomatic, isbest managed by continuous positive airway pressure (CPAP) ventilation.Diaphragmatic plication is recommended when after 2-3 weeks there is norecovery of diaphragmatic function or when there are troublesomerespiratory complications.
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