From January 1990 through December 1995, 43 patients underwent diaphragmatic plication for the management of phrenic nerve palsy complicating various pediatric cardiovascular surgery. Their mean age at plication was 11.1 months and sex ratio was
31
males to 12 females. In order of decreasing incidence, the primary cardiovascular procedures included modified Blalock-Taussig shunt(7), total correction for the Tetralogy of Fallot(7), arterial switch operation(6), unifocalization for the
pulmonary
atresia with VSD(3), modified Fontan operation(3), VSD patch closure(3) and others. The involved sides of diaphragm were right in 17, left in 23 and bilateral in 3. Extensive pericardial resection with electocauterization of resected margin was
thought
to be the most common cause of phrenic nerve palsy(20). The interval between primary operation and plication ranged from the day of operation to 98 days(median ll days). The methods of plication were central pleating technique(plication with
phrenic
nerve branch preservation)in 41, and other technique in 2. 10patients died after plication(7;early, 3; late), and the causes of death were thought to be unrelated to plication itself. Among the 36 early survivors, extubation or cessation of
positive
pressure ventilation could be accomplished between l and 24 days postoperatively(mean=4.5). Cumulative follow-up was 92 patient years without major complications. Postoperative follow-up fluoroscopy was performed in 6 patients, and the location
and
movement of plicated diaphragms were satisfactory in 5 patients. We concluded that diaphragmatic plication with preservation of phrenic nerve branch could lead to cessation of positive pressure ventilation and complete recovery of diaphragmatic
function
in the long term, unless the phrenic nerve was irreversibly damaged.
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