KẾT QỦA PHẪU THUẬT KHÂU GẤP NẾP CƠ HOÀNH ĐIỀU TRỊ LIỆT HOÀNH SAU MỔ TIM BẨM SINH

Abstract

Objective: To describe the clinical and paraclinical symptoms and surgical outcomes of diaphragmatic plication for treating diaphragmatic paralysis after congenital cardiac surgery. Summary: Diaphragmatic paralysis following cardiac surgery is a severe complication affecting patients’ respiration, with incidence rates ranging from 0.3% to 12.8% in different studies. This condition results from phrenic nerve injury, which may occur during thymectomy, pericardial adhesion dissection in patients with prior surgeries, or phrenic nerve burns due to electrocautery use. Clinical symptoms include prolonged mechanical ventilation, respiratory failure, and pneumonia, while older children may be asymptomatic. Diagnosis is confirmed via chest X-ray, ultrasound, or fluoroscopic examination of diaphragmatic movement. Various treatment approaches exist, but in young children, diaphragmatic plication is widely indicated. This study was conducted to evaluate the clinical and paraclinical symptoms and surgical outcomes of diaphragmatic plication in the treatment of diaphragmatic paralysis after congenital cardiac surgery. Methods: A retrospective cross-sectional study was conducted on 28 patients with diaphragmatic paralysis following congenital cardiac surgery from January 2020 to December 2024. Results: Among 1,839 patients who underwent surgery, 28 developed diaphragmatic paralysis. Of these, 6 patients had primary surgeries (1 after total anomalous pulmonary venous connection repair, 2 after ventricular septal defect repair, 1 after total repair of Tetralogy of Fallot, and 2 after unifocalization), while 22 had secondary surgeries (8 post-Glenn procedure, 8 post-Fontan procedure, 3 post-pulmonary artery conduit replacement, 2 post-complete atrioventricular septal defect repair, and 1 post-Senning procedure). Patients ranged in age from 2 months to 13 years. The primary signs of diaphragmatic paralysis included prolonged mechanical ventilation and extubation failure in 18 patients, postoperative dyspnea and tachypnea in 6 patients, and mild respiratory distress with radiographic evidence of diaphragmatic paralysis in 4 patients. The time from cardiac surgery to diaphragmatic plication ranged from 5 days to 3 months. Three patients died due to multiple organ failure, while the remaining patients showed respiratory recovery postoperatively. The diaphragm returned to a normal position in 20 patients within one month and in 5 patients within three months. During a mean follow-up of 16 months, 6 patients underwent further cardiac surgery, and no cases of pneumonia or respiratory failure were recorded. Conclusion: The primary signs of diaphragmatic paralysis following congenital cardiac surgery are prolonged mechanical ventilation and extubation failure. Early diaphragmatic plication surgery facilitates respiratory recovery in patients.