Abstract:

Aim: was to reveal factors, influencing high cnance of dysfuntion of diaphragm domes in further patient examination by estimation of dynamics of acqired diaphragmatic dysfunction after different cardiac surgical interventions.

Material and methods: research included 642 patients after different cardiac surgical interventions. We estimated mobility of diaphragm domes at the moment of patients discharge from intensive care unit and secondly before transporting to rehabilitation center. All patients were devided into 3 groups. 1st group: patients with normal mobility of diaphragm at initial examination - 395 (61,5%). 2nd group - diaphragmatic dysfunction at initial examination and recovered mobility at further examination - 173 patients (26,9%). 3rd group - patients with diaphragmatic dysfunction at both stages of examination - 74 (11,5%). Criteria for diaphragmatic dysfunction - mobility amplitude of domes less than 10 mm. We estimated chances of extant dysfunction, under the influence of complex of clinical and surgical factors.

Results: at initial examination diaphragmatic dysfunction was revealed at 38,5%, left dome - 18,2%, right dome - 10,3%, bilateral dysfunction - 10,0%. At further examination diaphragmatic dysfunction persisted in 11,5% of patients, left-sided - 7,5%, right-sided - 3,9%, bilateral - in one case. Recovery of diaphragmatic function was achieved in 70% of initial dysfunction. High and statistically significant chances of extant dysfunction were evaluated only in case of unilateral separation of internal thoracic artery (ITA). Other surgical and clinical factors had no statistically sugnificant influence.

Conclusions: aquired diaphragmatic dysfunction after different cardiac surgical interventions ir 70% of cases is reversible. Recovery of diaphragm mobility was full. Prevalence of diaphragmatic dysfunction decreases for 5 days from 38,5% to 11,5% and persists usually unilateral: left-sided - 7,5%, right-sided - 3,9%.

The only statistically significant surgical factor, influencing high risk of appearance and extantion of post-operative domes dysfunction is unilateral separation of ITA. 

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