Abstract
Introduction
Close proximity of phrenic nerves to pericardium and internal mammary arteries (IMA) makes them liable to injury during cardiac surgery which occurs due to its transection, compromised vascularity or hypothermia.
Methods
Between July, 1999 to August, 2000 fifty fresh cadavers were examined and the intrathoracic course of phrenic nerves was studied. This information was utilised while performing 200 open heart operations. Intermittent cooled saline (4°C) was used instead of ice slush for topical cooling and pericardiophrenic branch of IMA was preserved while harvesting it.
Results
Variations were observed in the anatomical relationship between the phrenic nerves and proximal internal mammary arteries. Incidence of unilateral phrenic nerve injury among patients who had open heart surgery was 1.5% and was 4% among patients in whom internal mammary artery was harvested.
Conclusion
A thorough knowledge of anatomical variations in the course of phrenic nerves, preservation of pericardiophrenic branch of IMA while harvesting it for CABG and use of cooled saline instead of ice slush for topical cooling helps in avoiding phrenic nerve injury during cardiac surgery. (Ind J Thome Cardiovasc Surg, 2001; 17: 225-229)
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Puri, D., Ch., M., Puri, N. et al. Prevention of post operative phrenic nerve palsy in patients undergoing cardiac surgery. Indian J Thorac Cardiovasc Surg 17, 225–229 (2001). https://doi.org/10.1007/s12055-001-0020-2
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DOI: https://doi.org/10.1007/s12055-001-0020-2