Breathing Difficulties

After open heart surgery five years ago for repair of my mitral valve, I began experiencing difficulty breathing – particularly when lying down. A chest x-ray indicated that my left diaphragm was “paralyzed”. I have two questions:

1.) Is it obvious that this “paralyzed” diaphragm is the cause of difficulty breathing?
2.) What procedures are available to determine if the cause of my breathing problem can be corrected? For example, I just read of President Bill Clinton’s similar symptoms after heart surgery, and it was determined he had scar tissue/adhesions as a result of the surgery causing one of his diaphragms to appear “paralyzed”. After removal of the adhesions, his breathing was restored. How were his adhesions diagnosed?

Thanks.        John

[National Jewish Health]

The occurrence of diaphragmatic paralysis following cardiac surgery is not uncommon.  It may or may not be spontaneously reversible, but after 5 years, should be deemed irreversible.  With regard to your first question, one should not assume that the paralyzed diaphragm is the cause of your shortness of breath, although that is highly likely, given the temporal relationship between the paralyzed diaphragm and the onset of your symptoms.  There are other causes of shortness of breath, including alterations in heart function, for example paradoxical motion of the septum of the heart.

There is great individual variability in the degree of shortness of breath experienced in response to diaphragmatic paralysis, varying from little or none to a lot.

Careful radiologic assessment should be able to distinguish between adhesions and true paralysis.  Stimulation of the phrenic nerve could also be used to distinguish between the two.

In the instance of true paralysis, a surgical procedure called diaphragmatic plication has proven to be effective in relieving dyspnea, in many instances.

You might want to discuss this with your doctors, after it is confirmed that there is not another cardiac or pulmonary cause of shortness of breath.

Good luck.