From March 1986 to August 1992, 18 patients underwent diaphragmatic plication for the diaphragmatic paralyses complicating various pediatric cardiac procedures. Age at operation ranged from 16 day to 84 months with mean age of 11.8 months. In
order
of
decreasing incidence, the primary cardiac procedures included modified Blalock-Taussig shunt (5), Arterial switch operation (4), modified Fontan operation (2), and others (7). The suspicious causes of phrenic nerve injury included overzealous
pericardial resection (7), direct trauma during the procedure (6), dissection of fibrous adhesion around the phrenic nerve (3) and unknown etiology (2). The involved sides of diaphragm were right in 10, left in 7 and bilateral in one. The
diagnosis
was
suspected by the elevation of hemidiaphragm on chest x-ray an confirmed by fluoroscopy. The interval between primary operation and plication ranged from the day of operation to 38 postoperative days (mean; 14 days). The method of plication were
'Central
pleating technique' described by Schwartz in 16 and other techniques in 2.
Five patients expired after plication and the cause of death were not thought to be correlated directly with the plication itself. In the remaining 13 survivors, extubation or cessation of positive ventilation could be done between the periods of
the
day of plication and 14th postoperative days (mean; 3.8day). We have made the following conclusion: 1) Phrenic nerve paralyses are relatively common complication after pediatric cardiac procedures and the causes of phrenic nerve injury are mostly
preventable; 2) Phrenic nerve palsy is associated with considerable morbidity; 3) diaphragmatic plication is safe, reliable and can be applicable in patients who are younger age and require prolonged positive pressure ventilation.
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