Bilateral phrenic nerve palsy following aortic valve surgery.

Bilateral phrenic nerve palsy is an extremely rare but serious complication of open cardiac surgery. We report the case of a 78-year-old female who underwent elective aortic valve replacement and coronary artery bypass grafting under hypothermic cardiopulmonary bypass. Despite otherwise unremarkable postoperative recovery, the patient could not be weaned off ventilatory support. A chest radiograph and radiological screening of the diaphragm confirmed the diagnosis of bilateral phrenic nerve palsy. Following bilateral hemi diaphragm placation and extensive respiratory rehabilitation the patient was discharged several months after initial surgery breathing independently. Literature review revealed only two similar cases. Many contributing factors have been described but the etiology of bilateral phrenic nerve palsy following open cardiac surgery still remains unclear. Raised awareness of this condition is essential.