Diaphragmatic paralysis after surgery in a patient with scimitar syndrome: A case report
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Department of Anesthesiology and Reanimation, Kartal Kosuyolu Heart Training and Education Hospital, Istanbul, Turkey
Ömer Faruk Şavluk   

Kartal Kosuyolu Education and Research Hospital, Kartal, Istanbul, Turkey. Tel.: +90 5056877440.
Submission date: 2014-09-21
Acceptance date: 2015-04-29
Online publication date: 2015-08-07
Publication date: 2020-03-26
Pol. Ann. Med. 2015;22(2):129–131
Scimitar syndrome is a complex congenital disorder affecting the right lung. Diaphragma paralysis is one of the important causes of morbidity and mortality in congenital heart surgery especially under 2 years of age in pediatric cardiac surgery. Phrenic nerve injury is a complication which occurs after cardiothoracic surgery and causes increased morbidity and mortality by leading diaphragmatic paralysis.

We present this rare pulmonary anomaly case of the patient who remained connected for a long time to respiratory equipment as a result of phrenic nerve palsy which developed and was eventually discharged with healing.

Case study:
A 6 months of age and 4.5 kg infant was admitted because of recurrent lung infections. It has been seen in posteroanterior chest X-ray and chest tomography that the right lung was hypoplasic and the heart was displaced to the right side of the body. The decision of surgery was taken for the patient who was discussed in the Council. The patient was extubated on 14th postoperative day. Paradoxical diaphragmatic movement was detected as the results of the examination of the patient and fluoroscopy. The patient was discharged from the intensive care unit on 49th postoperative day.

Results and discussion:
If the cases require mechanical respiratory support after congenital heart surgery despite intra-cardiac full correction is done and if there was no problem in cardiac function, the paralysis of the diaphragm should be considered. The difference in the recovery time of the phrenic nerve and diaphragm function is thought to be related to the degree of the phrenic nerve injury.

Decrease in action potential amplitude and/or delay or non-response in phrenic nerve latency suggesting or supporting the phrenic nerve lesion are observed in infants and young children mostly in the early period after cardiac surgery. However, this situation is temporary and good care during this period provides restoring the patient's health.

Conflict of interest.
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