Case Report Recurrent Respiratory insufficiency Associated with Phrenic Nerve Paralysis after Coronary Artery Bypass Grefting: A Case Report

Eventration of the diaphragm is generally regarded as a condition in which the left or the right leaf of the diaphragm has ascended abnormally high into the chest. The eventration may result from an acquired affection leading to permanent destruction of the phrenic nerve. Phrenic nerve injury is a well-recognised complication of cardiac surgery that can lead to disabling effects from diaphragmatic dysfunction, especially in children and patients with a history of chronic obstructive airway disease. Various mechanisms of injury have been recognised including hypothermia, mechanical trauma and possibly ischaemia. A clear understanding of these mechanisms is important in order to modify surgical techniques to prevent this serious complication of cardiac surgery. Diaphragmatic plication is intended to decrease lung compression, to make the thoracic base and mediastinum more stable, and to strengthen the respiratory action of intercostal, perithoracic, and abdominal muscles. In this case report, a 59-year-old male patient who developed recurrent respiratory insufficiency associated with phrenic nerve paralysis and diaphragmatic eventration after coronary artery bypass graftingin the intensive care unit was presented.