Chest
Clinical InvestigationsTime Course of Recovery from Frostbitten Phrenics after Coronary Artery Bypass Graft Surgery
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.
REFERENCES (18)
- et al.
The effect of pericardial insulation on hypothermic phrenic nerve injury during open-heart surgery
Ann Thorac Surg
(1987) - et al.
Bilateral diaphragmatic paralysis following topical cardiac hypothermia
Chest
(1984) - et al.
Postoperative phrenic nerve palsy in patients with open-heart surgery
Ann Thorac Surg
(1985) - et al.
Bilateral diaphragm paralysis complicating local cardiac hypothermia during open heart surgery
Am J Med
(1984) - et al.
Diagnosis of diaphragmatic dysfunction
Clin Chest Med
(1987) Tests of respiratory muscle function
Clin Chest Med
(1988)- et al.
Topical cardiac hypothermia and phrenic nerve injury
Ann Thorac Surg
(1977) Discussion
J Thorac Cardiovasc Surg
(1963)- et al.
Incidence and etiology of a raised hemidiaphragm after CABG
Thorax
(1985)