Atypical presentation of bilateral phrenic nerve palsy and its unusual recovery after coronary artery bypass grafting. The Thoracic and cardiovascular surgeon 54; 7 2006 Oct. pg. 501 -4.

Abstract

Bilateral phrenic nerve paralysis after coronary artery bypass surgery in a 47-year-old female patient is reported. This became evident on the 5th post-extubation day and mimicked acute coronary syndrome and led to difficulty in diagnosis. The patient required re-intubation and mechanical ventilation for only 6 days. The diagnosis of clinical and radiological abnormalities suggestive of bilateral phrenic nerve dysfunction was assisted by fluoroscopy, measurement of needle electromyography, and phrenic nerve motor conduction studies. The patient was followed up postoperatively for 14 weeks with complete regression of the neuropathy one month after surgery. An awareness of this complication should lead to improved care and successful postoperative management of patients.

Key words

Coronary bypass surgery - bilateral phrenic nerve palsy - needle electromyography

Introduction

Takayasu’s arteritis was first described in 1908. This is a non-specific granulomatous panarteritis affecting the large and medium sized arteries1 . This disease has a prediliction for young Asian women; the etiology is unknown. The incidence of coronary artery involvement in Takayasu’s arteritis is about 10%1,2; coronary ostia are most frequently involved (73%) and less frequently the proximal vessels3 . The ischemia caused by coronary lesions in Takayasu’s arteritis is one of the major cause of death. Patients with left main ostial stenosis complicating Takayasu’s arteritis require myocardial revascularization, however the selection of graft material is controversial. As the branch vessels of the aorta are often affected by Takayasu’s disease, vein grafts are preferable4 . We report a case of Takayasu’s arteritis with ostial stenosis of the left main coronary artery (LMCA) and also involving the proximal segment of the left subclavian artery (LSA) where coronary artery bypass grafting (CABG) was done using the right internal thoracic artery (RITA).