Chest
Volume 99, Issue 5, May 1991, Pages 1112-1115
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Clinical Investigations
Time Course of Recovery from Frostbitten Phrenics after Coronary Artery Bypass Graft Surgery

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Bilateral diaphragmatic paralysis developed in a patient after coronary artery bypass graft surgery during which cold cardioplegia was used. The patient's progress and eventual recovery over an 18-month period is described, with particular reference to chest wall motion and respiratory pressure measurements. (Chest 1991; 99:1112-15)

Section snippets

CASE REPORT

A 56-year-old white man was seen in consultation for evaluation of severe orthopnea 16 days after he had undergone coronary artery bypass grafting. Since his operation, he had noticed shortness of breath when lying supine. He tolerated lying on his side for longer periods than lying supine. He denied cough or paroxysmal nocturnal dyspnea. His exercise tolerance had improved since the operation because of absence of angina, and he had been able to walk an average of two miles daily during the

DISCUSSION

Bilateral diaphragmatic paralysis secondary to bilateral phrenic nerve damage occurs in about 1 percent to 3 percent of patients undergoing coronary artery bypass grafting.6, 8 Two postulated causes of the phrenic nerve injury are stretch, which may occur during either retraction of the sternum or manipulation of the pericardium, and hypothermia caused by the iced saline solution instilled into the pericardial sac during cold cardioplegia.

The first evidence of phrenic nerve damage in the

ACKNOWLEDGMENT

We thank Mrs. Lori Oeltjenbruns for secretarial assistance.

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