Hemidiaphragmatic paralysis increases postoperative morbidity after a modified Fontan operation

Zahid Amin, Doff B. McElhinney, Jennifer K. Strawn, John D. Kugler, Kim F. Duncan, V. Mohan Reddy, Edwin Petrossian, Frank L. Hanley, Marshall L. Jacobs, Peter B. Manning, Thomas L. Spray, Florentino Vargas, Joseph J. Amato

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objectives: After a Fontan procedure, forward pulmonary blood flow is augmented during inspiration because of negative intrathoracic pressure. Total pulmonary blood flow is higher during inspiration. With hemidiaphragmatic paralysis, inspiratory augmentation of pulmonary flow is lost or diminished. The objective of this study was to compare early postoperative morbidity after the modified Fontan operation in patients with and without hemidiaphragmatic paralysis. Methods: A case-control analysis was performed comparing 10 patients with documented hemidiaphragmatic paralysis against 30 patients without paralysis who were matched for diagnosis, fenestration, and age. The following early postoperative outcomes were assessed: duration of ventilator support, duration of hospital stay, incidence of ascites, prolonged effusions, and readmission. Results: Preoperatively, there were no significant differences between the 2 groups. However, among the postoperative outcomes, the duration of hospital stay (25.4 ± 16.6 days vs 10.8 ± 6.3 days; P = .03), incidence of ascites (70% vs 3%; P < .001), prolonged pleural effusions (60% vs 13%; P =.007), and readmission (50% vs 7%; P = .007) were significantly greater in patients with hemidiaphragmatic paralysis than in those without hemidiaphragmatic paralysis. Conclusions: Hemidiaphragmatic paralysis after the modified Fontan operation is associated with an increase in early morbidity. Care should be taken to avoid injury to the phrenic nerve. Patients with prolonged effusions should be evaluated for hemidiaphragmatic paralysis.

Original languageEnglish (US)
Pages (from-to)856-862
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume122
Issue number5
DOIs
StatePublished - Nov 1 2001

Fingerprint

Fontan Procedure
Paralysis
Morbidity
Ascites
Lung
Length of Stay
Phrenic Nerve
Incidence
Pleural Effusion
Mechanical Ventilators
Pressure
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Amin, Z., McElhinney, D. B., Strawn, J. K., Kugler, J. D., Duncan, K. F., Reddy, V. M., ... Amato, J. J. (2001). Hemidiaphragmatic paralysis increases postoperative morbidity after a modified Fontan operation. Journal of Thoracic and Cardiovascular Surgery, 122(5), 856-862. https://doi.org/10.1067/mtc.2001.118506

Hemidiaphragmatic paralysis increases postoperative morbidity after a modified Fontan operation. / Amin, Zahid; McElhinney, Doff B.; Strawn, Jennifer K.; Kugler, John D.; Duncan, Kim F.; Reddy, V. Mohan; Petrossian, Edwin; Hanley, Frank L.; Jacobs, Marshall L.; Manning, Peter B.; Spray, Thomas L.; Vargas, Florentino; Amato, Joseph J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 122, No. 5, 01.11.2001, p. 856-862.

Research output: Contribution to journalArticle

Amin, Z, McElhinney, DB, Strawn, JK, Kugler, JD, Duncan, KF, Reddy, VM, Petrossian, E, Hanley, FL, Jacobs, ML, Manning, PB, Spray, TL, Vargas, F & Amato, JJ 2001, 'Hemidiaphragmatic paralysis increases postoperative morbidity after a modified Fontan operation', Journal of Thoracic and Cardiovascular Surgery, vol. 122, no. 5, pp. 856-862. https://doi.org/10.1067/mtc.2001.118506
Amin, Zahid ; McElhinney, Doff B. ; Strawn, Jennifer K. ; Kugler, John D. ; Duncan, Kim F. ; Reddy, V. Mohan ; Petrossian, Edwin ; Hanley, Frank L. ; Jacobs, Marshall L. ; Manning, Peter B. ; Spray, Thomas L. ; Vargas, Florentino ; Amato, Joseph J. / Hemidiaphragmatic paralysis increases postoperative morbidity after a modified Fontan operation. In: Journal of Thoracic and Cardiovascular Surgery. 2001 ; Vol. 122, No. 5. pp. 856-862.
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abstract = "Objectives: After a Fontan procedure, forward pulmonary blood flow is augmented during inspiration because of negative intrathoracic pressure. Total pulmonary blood flow is higher during inspiration. With hemidiaphragmatic paralysis, inspiratory augmentation of pulmonary flow is lost or diminished. The objective of this study was to compare early postoperative morbidity after the modified Fontan operation in patients with and without hemidiaphragmatic paralysis. Methods: A case-control analysis was performed comparing 10 patients with documented hemidiaphragmatic paralysis against 30 patients without paralysis who were matched for diagnosis, fenestration, and age. The following early postoperative outcomes were assessed: duration of ventilator support, duration of hospital stay, incidence of ascites, prolonged effusions, and readmission. Results: Preoperatively, there were no significant differences between the 2 groups. However, among the postoperative outcomes, the duration of hospital stay (25.4 ± 16.6 days vs 10.8 ± 6.3 days; P = .03), incidence of ascites (70{\%} vs 3{\%}; P < .001), prolonged pleural effusions (60{\%} vs 13{\%}; P =.007), and readmission (50{\%} vs 7{\%}; P = .007) were significantly greater in patients with hemidiaphragmatic paralysis than in those without hemidiaphragmatic paralysis. Conclusions: Hemidiaphragmatic paralysis after the modified Fontan operation is associated with an increase in early morbidity. Care should be taken to avoid injury to the phrenic nerve. Patients with prolonged effusions should be evaluated for hemidiaphragmatic paralysis.",
author = "Zahid Amin and McElhinney, {Doff B.} and Strawn, {Jennifer K.} and Kugler, {John D.} and Duncan, {Kim F.} and Reddy, {V. Mohan} and Edwin Petrossian and Hanley, {Frank L.} and Jacobs, {Marshall L.} and Manning, {Peter B.} and Spray, {Thomas L.} and Florentino Vargas and Amato, {Joseph J.}",
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T1 - Hemidiaphragmatic paralysis increases postoperative morbidity after a modified Fontan operation

AU - Amin, Zahid

AU - McElhinney, Doff B.

AU - Strawn, Jennifer K.

AU - Kugler, John D.

AU - Duncan, Kim F.

AU - Reddy, V. Mohan

AU - Petrossian, Edwin

AU - Hanley, Frank L.

AU - Jacobs, Marshall L.

AU - Manning, Peter B.

AU - Spray, Thomas L.

AU - Vargas, Florentino

AU - Amato, Joseph J.

PY - 2001/11/1

Y1 - 2001/11/1

N2 - Objectives: After a Fontan procedure, forward pulmonary blood flow is augmented during inspiration because of negative intrathoracic pressure. Total pulmonary blood flow is higher during inspiration. With hemidiaphragmatic paralysis, inspiratory augmentation of pulmonary flow is lost or diminished. The objective of this study was to compare early postoperative morbidity after the modified Fontan operation in patients with and without hemidiaphragmatic paralysis. Methods: A case-control analysis was performed comparing 10 patients with documented hemidiaphragmatic paralysis against 30 patients without paralysis who were matched for diagnosis, fenestration, and age. The following early postoperative outcomes were assessed: duration of ventilator support, duration of hospital stay, incidence of ascites, prolonged effusions, and readmission. Results: Preoperatively, there were no significant differences between the 2 groups. However, among the postoperative outcomes, the duration of hospital stay (25.4 ± 16.6 days vs 10.8 ± 6.3 days; P = .03), incidence of ascites (70% vs 3%; P < .001), prolonged pleural effusions (60% vs 13%; P =.007), and readmission (50% vs 7%; P = .007) were significantly greater in patients with hemidiaphragmatic paralysis than in those without hemidiaphragmatic paralysis. Conclusions: Hemidiaphragmatic paralysis after the modified Fontan operation is associated with an increase in early morbidity. Care should be taken to avoid injury to the phrenic nerve. Patients with prolonged effusions should be evaluated for hemidiaphragmatic paralysis.

AB - Objectives: After a Fontan procedure, forward pulmonary blood flow is augmented during inspiration because of negative intrathoracic pressure. Total pulmonary blood flow is higher during inspiration. With hemidiaphragmatic paralysis, inspiratory augmentation of pulmonary flow is lost or diminished. The objective of this study was to compare early postoperative morbidity after the modified Fontan operation in patients with and without hemidiaphragmatic paralysis. Methods: A case-control analysis was performed comparing 10 patients with documented hemidiaphragmatic paralysis against 30 patients without paralysis who were matched for diagnosis, fenestration, and age. The following early postoperative outcomes were assessed: duration of ventilator support, duration of hospital stay, incidence of ascites, prolonged effusions, and readmission. Results: Preoperatively, there were no significant differences between the 2 groups. However, among the postoperative outcomes, the duration of hospital stay (25.4 ± 16.6 days vs 10.8 ± 6.3 days; P = .03), incidence of ascites (70% vs 3%; P < .001), prolonged pleural effusions (60% vs 13%; P =.007), and readmission (50% vs 7%; P = .007) were significantly greater in patients with hemidiaphragmatic paralysis than in those without hemidiaphragmatic paralysis. Conclusions: Hemidiaphragmatic paralysis after the modified Fontan operation is associated with an increase in early morbidity. Care should be taken to avoid injury to the phrenic nerve. Patients with prolonged effusions should be evaluated for hemidiaphragmatic paralysis.

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