Abstract
Chest roentgenograms of 163 consecutive cardiac surgical procedures were serially reviewed to determine the incidence and prognosis of elevated hemidiaphragm (ED), and any relationship with the use of topical ice slush in myocardial preservation. Diagnosis was based on radiographic criteria, comparing preoperative chest roentgenograms with postoperative ones. All patients were treated with similar myocardial preservation techniques including moderate hypothermia. Subjects were 59 child patients, 73 adult patients with acquired valve disease, and 31 adult patients treated with coronary artery bypass grafting (CABG). Of the 163 patients ED occurred in 20 (12.3%), which all located in the left side. The 20 patients included one (1.6%) out of 59 children, 10 (13.6%) out of 73 adults with acquired valve disease, and 9 (29%) out of 31 treated with CABG. When the ED cases were compared with normal cases for various operative factors, a significant difference (p<0.05) was noted in the lowest myocardial temperature. Nineteen cases could be followed on an ambulant basis. Of the 19 cases 5 (26%) recovered within 3 months, 14 (70%) within 12 months, and 18 (94%) within 2 years. Only one case still revealed ED 5 years after surgery. Phrenic nerve palsy was transient and was of no clinical significance except when bilateral. Recovery of ED on a chest roentgenography demanded a considerable period, however, early recovery in pulmonary function could be observed.
