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2009, Number 1

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Rev Mex Cir Pediatr 2009; 16 (1)

Video Assisted Diaphragmatic plication in Children with post ventilatory cardiothoracic surgery unit

Ponce-Ramos LA, Ortega-Salgado JA, Mendoza-Hernández J
Full text How to cite this article

Language: Spanish
References: 8
Page: 25-28
PDF size: 88.40 Kb.


Key words:

diaphragmatic paralysis, Cardiothoracic Surgery, early plication.

ABSTRACT

Introduction: Diaphragmatic paralysis (PD) after Cardiothoracic Surgery (CCT) is secondary to phrenic nerve injury, whether due to ice, electro cautery, or dissection. The aim of this paper is to show that early plication by Video Assisted Thoracic Surgery (VATS) in patients with PD secondary to CST is a move beneficial because it allows weaning quickly and avoid complications inherent to prolonged intubation and ventilation mechanically assisted.
Material and Methods: Retrospective study in March 2007 to March 2008, which included five children with diaphragmatic paralysis secondary CCT complex congenital diaphragmatic plication was indicated by ventilator dependence, elevated venous pressure, atelectasis and recurrent pneumonia.
Results: All surgeries were achieved using VATS, the patient recovered from first to fifth day postsurgery, only one child, weaning was not achieved by neurological damage and have filed multiple organ failure caused him to death two weeks. Currently all patients are under observation with periodic clinical and radiological proper position of the diaphragm, as well as lung reexpansion.
Conclusions: With advances in video-assisted thoracic surgery offers advantages diaphragmatic plication well documented in these patients, since it avoids the complications of prolonged intubation and mechanical ventilation and which allows to remove them


REFERENCES

  1. Ilse Contreras, Raul Escobar, M. Cecilia Necochea: Tres Casos de Parálisis Diafragmática: Utilidad del estudio Electromiográfico. Rev Chil. Pediatr. 2004; 75(1): 48 – 54.

  2. D.A Simansky, M. Paley, Y Rafaela, A. Yellin: Diaphragm plication following phrenic nerve injury: a comparision of paediatric and adult patients. Thorax 2002; 57: 613 – 616.

  3. Becmeur F, Talon I, Schaarschmidt K, y cols: Thoracoscopic diafhragmatic eventration repair in children: about 10 cases. Journal of Pediatric Surgery 2005; 40: 1712- 1715.

  4. Hwang Mao – Sheng, Chu Jaw-ji, Su wen-Jen; Diaphragmatic Paralysis caused by malposition of chest tube placement after pediatric cardiac surgery. International Journal of cardiology 2005; 99: 129 – 131.

  5. Hines Michel H. Video – Assisted Diaphragm Plication In Children; Ann Thorac Surg 2003; 76: 234 – 6.

  6. Quintana González J.I, Carbajo M., Rodríguez J. y cols. Paralisisi Diafragmática unilateral tratada con éxito mediante plicatura diafragmatica. Arch Bronconeumol 2001; 37: 401 – 403.

  7. Bowman E. D, Murton L.J. A case of neonatal bilateral diaphragmatic parálisis requiring surgery. Aust. Paediatr. J. 1984; 20: 331 – 332.

  8. de Leeuw Maaike, William JoyceM, Freedom Robert, William W. G. et all. Impact of Diaphragmatic paralysis after cardiothoracic surgery in children. The Journal of Thoracic and Cardiovascular Surgery 1999; 118 (39): 510 – 517.




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Rev Mex Cir Pediatr. 2009;16