left lung diaphram paralysys

[GARY521]

My wife recentley had a left lung transplant. She suffers from severe COPD. It appears that the phrenic nerve was damaged during the transplant. It has been 21 days since the operation, and the left lung is not functioning due to the nerve damage to the diaphram. Is it possible that the diaphram and phrenic nerve will heal itself?  If so, what is the estimated time that it may take. take? Is there history/case studies on similar diaphram paralysys and restoration of the diaphram and phrenic nerve?  Who are the experts and what are their associated Hospitals.

[National Jewish Health]

Phrenic nerve dysfunction is a well-known complication of cardiac surgery, heart-lung transplantation and lung transplantation.  The duration of the dysfunction is unpredictable and varies from days to weeks to months to indefinitely.  After a lengthy period of time has passed and the chance of spontaneous recovery greatly reduced, a surgical procedure called plication of the diaphragm has been implemented with variable but modest success.

The answer to your question about how long it may take for spontaneous recovery depends on the nature of the nerve injury; whether it was simply stretched or otherwise traumatized during surgery but remained anatomically intact vs. completely severed or crushed.  A first step in nerve function assessment would be a phrenic nerve conduction study, followed by assessment of responsiveness of the diaphragm muscle to direct stimulation.  This is a complicated, very specialized evaluation; one to be conducted only by those with expertise in this field.  Such specialists would be found at almost any major transplant center in the U.S.

I suggest you begin by contacting the investigators listed below.  They would surely be aware of work on this problem being done by other groups in the international community and be able to refer you to them.
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Yvonne Berk, MD
Wim van der Bij, MD, PhD
Michiel E. Erasmus, MD, PhD
Peter J. Wijkstra, MD, PhD

Department of Pulmonary Diseases, Center of Home Mechanical Ventilation, University Medical Center Groningen, Groningen, The Netherlands

REFERENCES
1. Maziak DE, Maurer JR, Kesten S. Diaphragmic paralysis: a complication of lung transplantation. Ann Thorac Surg 1996;61:170 –3.
2. Sheridan PH, Cheriyan A, Doud J, et al. Incidence of phrenic neuropathy after isolated lung transplantation. J Heart Lung Transplant 1995;14:684–91.
3. Ferdinande P, Bruyninckx F, Van Raemdonck D, Daenen W, Verleden G. Phrenic Nerve dysfunction after heart–lung and lung transplantation. J Heart Lung Transplant 2004;23:105–9.
4. Wijkstra PJ, Meijer PM, Meinesz AF. Diaphragmic plication following phrenic nerve injury. Thorax 2003;58:460.
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You might also begin by questioning members of the team that performed your wife’s surgery regarding local experts.  Finally, you would do well by contacting transplant teams at the Mayo Clinic, the Cleveland Clinic and the Methodist DeBakey Heart Center at http://www.methodisthealth.com/tmhs/mdhvc.do?channelId=-1073829260&contentId=1073790395&contentType=SERVICE_CONTENT_TYPE.

Note the following from http://www.methodisthealth.com/tmhs/basic.do?channelId=-1073830691&contentId=1073892202&contentType=SERVICE_CONTENT_TYPE

The Electromyography (EMG) and Motor Control Laboratory

The Methodist Hospital Neurological Institute Electromyography (EMG/NCV) and Motor Control Laboratory, staffed by four neurologists, welcomes patients with weakness and numbness. Our focus includes myopathy, neuropathy, cervical and lumbar radiculopathy, carpal tunnel syndrome, nerve entrapment syndromes, motor neuron disease, muscular dystrophy, and other disturbances of neuromuscular compromise. We also provide expertise in critical care neuropathy and myopathy, evaluating phrenic nerve and diaphragm dysfunction. Further, we specialize in patients with pelvic floor dysfunction, addressing urinary and rectal compromise.

Click here to get directions to our lab.

To Contact Our Laboratory:
The EMG and Motor Control Laboratory
Dr. David B. Rosenfield – Director

TMH – West Pavilion
6447 Main St 11th fl – Entrance is thru Smith Tower 3rd fl.
Houston, Texas 77030
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