BACKGROUND: Phrenic nerve injury (PNI) is an annoying complication after cardiac surgery. Severe respiratory distress, prolonged ventilator use and hospital stay are common problems in the infantile patients. Early diaphragm plication vs. conservative therapy has been a debatable issue.

METHODS: We retrospectively review the medical records of our pediatric patients having heart surgeries for congenital heart disease (CHD) in this tertiary referring hospital during Oct. 1999 through Oct. 2008. Diagnosis of PNI was confirmed by chest x-ray, ultrasound and fluoroscope studies. The CHD of these PNI patients include TAPVR, TOF, Asplenic syndrome, ECD and VSD. Their demographic data and details of operations and postoperative course are compared between these 2 groups of management.

RESULT: Thirteen of 545 patients (2.4%) are found to be complicated with postoperative PNI. Eight patients suffered right side PNI, four left side and only one was bilateral PNI. The Age, ventilator days and hospitalization days in patients of conservative treatment are 8-days-to-5-years, 26.3 ± 20.9 days and 50.1 ± 30.9 days respectively, as well as 4-days-to-9-months, 71.6 ± 14.1 days and 80.0 ± 26.8 days respectively in patients receiving diaphragm plication therapy. Also, in all PNI patients older than 6 months of age extubation is always successfully in two weeks of operation whereas in those younger than 6months prolonged ventilator dependence is the rule.

CONCLUSION: We recommend early diaphragm plication on PNI patients younger than 6months of age or suffering bilateral PNI.