Sharjeel Abbas, Adeel Abbas, Shahid Amin, Madiha Iqbal, Waseem Riaz, Jawad Sajid Khan.
Phrenic nerve injury from ice slush placed during multi-cardiac valve repair / replacement.
J Cardiovascular Dis Jan ;12(4):97-100.

OBJECTIVE:To find out the frequency of phrenic nerve injury in our patients undergoing heart valve surgeries (mitral, aortic & tricuspid, in any combination) MATERIAL AND METHODS: This study was performed at Cardiothoracic Department, Punjab Institute of Cardiology, Lahore, from 1st January 2009 to 31st December 2015. A total of 2087 patients underwent valve repair and replacements during the study period. DVR and mitral / aortic valve replacement with tricuspid valve repair was taken on 789 patients. Both men and women aged 20-55 years, undergoing elective DVR or MVR+TVr or AVR+TVr were included in the study. SPSS (Statistical Package for Social Sciences) for Windows version 21 was used for the analysis of data.A p-value of ≤0.05 was taken as significant. RESULTS:A total of 789 patients underwent multiple valve replacement/repair. The mean age of patients was 33.21 years, median being 34 years. Male patients accounted for 337 (42.7%) patients and females being 452 (57.3%) in number. Total ICU stay remained ≤2 days in 88%, whereas hospital stay remained upto 7 days in 88.8%. Time on mechanical ventilation was ≤2 days in 98%. Pleural effusion was found in 25 patients (3.2%). Chest intubation was performed in 17 patients (2.2%). Seven patients (0.9%) developed nosocomial pneumonia. In 40 patients chest x ray showed atelectasis, whereas elevated left hemidiaphragm was found in 4 (0.5%) patients. There was decreased left sided abdominal movement in all of these 4 patients, found relieved at 6 months followup. CONCLUSION:Phrenic nerve injury is a rare but reversible complication of valvular heart replacement / repair. Once occurred it increases morbidity. KEY WORDS: ICE slush phrenic injury, Cardiac valve repair / replacement.

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