Elevated hemidiaphragm after cardiac operations: Incidence, prognosis, and relationship to the use of topical ice slush

• Published in: The Annals of thoracic surgery Vol. 48; no. 6; pp. 764 - 768
• Main Authors: Curtis, Jack J., Nawarawong, Weerachai, Walls, Joseph T., Schmaltz, Richard A., Boley, Theresa, Madsen, Richard, Anderson, Sharon K.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-12-1989; Elsevier Science
• Subjects: Biological and medical sciences; Coronary Artery Bypass - methods; Diaphragm - diagnostic imaging; Follow-Up Studies; Heart Arrest, Induced - adverse effects; Heart Arrest, Induced - methods; Humans; Ice - adverse effects; Medical sciences; Phrenic Nerve - injuries; Prognosis; Radiography; Respiratory Paralysis - etiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Heart; Human; Heightening; Correlation; Surgery; Conservation; Cardiovascular disease; Diaphragm; Technique; Incidence
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/0003-4975(89)90667-X

We have reviewed chest roentgenograms of 745 patients before hospital dismissal after cardiac operations and serially to determine the incidence and prognosis of elevated hemidiaphragm and any relationship to the use of topical ice slush (TIS) in myocardial preservation. All patients had similar myocardial preservation techniques including moderate systemic hypothermia and 4 °C saline solution poured over the heart at aortic clamping. During a 12-month period, TIS was added to the saline bath. Two (2.4%) of 84 patients before TIS and 5 (2.5%) of 201 consecutive patiente operated on since discontinuing TIS had elevated hemidiaphragm on the predismissal roentgenogram. Of 460 patients in whom TIS was employed, 109 (23.7%) had elevafed hemidiaphragm (
p < 0.001). When TIS was employed, elevated hemidiaphragm developed in 72 (26%) of 280 patients without internal mammary artery takedown versus 13 of 33 patients (39.4%) with takedown of the internal mammary artery (
p = 0.047). Ninety-nine patients with elevated hemidiaphragm were available for follow-up at 1 month, at which time 79 (79.8%) continued to have elevated diaphragm. At 1 year, 14 (21.9%) of 64 patients had persistent diaphragm elevation. We conclude that TIS predisposes to elevated diaphragm and that the incidence is increased when the internal mammary artery is harvested.