Bilateral phrenic nerve paralysis after the Mustard procedure. Experience with four cases and recommendations for management.

Unilateral phrenic nerve injury is a recognized complication of thoracic operations, but bilateral diaphragmatic paralysis after an intracardiac procedure in an infant has not previously been described. In the past 10 years, four infants have sustained a bilateral phrenic nerve injury during the performance of a Mustard procedure. They were managed with tracheostomy and prolonged mechanical ventilation. Their recovery period ranged between 30 and 103 days and each had a satisfactory outcome. This technique was preferred to bilateral diaphragmatic plication because the results of that procedure have been equivocal. Tracheostomy reduced the catastrophic risk of an obstructed endotracheal tube, allowed immediate oral intake, and simplified the weaning process from the ventilator.