Turkiye Klinikleri Cardiovascular Sciences

.: REVIEW
Brachial Plexus Injury After Cardiac Surgery: Traditional Review
Kalp Cerrahisi Sonrası Brakial Pleksus Yaralanması: Geleneksel Derleme
Mansour JANNATIa
aDepartment of Cardiovascular Surgery, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, IRAN
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(3):142-8
doi: 10.5336/cardiosci.2021-84385
Article Language: EN
Full Text
ABSTRACT
 Neurologic problems after cardiac surgery are not unusual. Peripheral nerve injury is determined as incomplete or complete or both motor or sensory function loss. The involved nerves are including the brachial plexus, median nerve, ulnar nerve, and radial nerve. One of the prevalent types of peripheral nerve injuries that happen after coronary artery bypass grafting is brachial plexus injury. Brachial plexus injury is an uncommon and under-recognized complication after cardiac surgeries that may lead to a permanent or temporary sensitivity or motor function deficit. Many mechanisms have been recommended for brachial plexus injury after cardiac surgeries comprising sternal retractor placement, internal mammary artery harvesting, hyper-abduction of arm and poor positioning of patients during the operation, and central venous catheter and implantable cardioverter-defibrillator insertion. The diagnosis of brachial plexus injury is challenging due to its complex anatomy. Clinical assessment, magnetic resonance imaging especially high-resolution 3T magnetic resonance neurography, electroneuromyography, and somatosensory evoked potential monitoring are considered as useful methods in the diagnosis of brachial plexus injury. Several strategies are suggested for the prevention and reduction of brachial plexus injury that are including the exact sternal retraction, the prevention from constant and asymmetrical traction, the hands-up position during surgery, and avoiding unsuitable sternal retraction in preparation of internal mammary artery. This review evaluates the occurrence, mechanisms, diagnostic, and preventive measurements of brachial plexus injury after cardiac surgery.

Keywords: Brachial plexus injury; cardiac surgery; neurological injury
ÖZET
 Kalp cerrahisi sonrası nörolojik problemler olağan dışı değildir. Periferik sinir hasarı, eksik veya tam veya hem motor hem de duyusal fonksiyon kaybı olarak belirlenir. İlgili sinirler; brakial pleksus, medyan sinir, ulnar sinir ve radyal siniri içerir. Koroner arter baypas greftlemesinden sonra meydana gelen yaygın periferik sinir yaralanmalarından biri brakial pleksus yaralanmasıdır. Brakiyal pleksus yaralanması, kalp ameliyatlarından sonra kalıcı veya geçici hassasiyet veya motor fonksiyon eksikliğine yol açabilen nadir görülen ve yeterince tanınmayan bir komplikasyondur. Kalp ameliyatları sonrası brakial pleksus yaralanması için sternal ekartör yerleştirme, iç meme arteri toplama, ameliyat sırasında kolun hiperabdüksiyonu, hastaların kötü konumlandırılması, santral venöz kateter ve implante edilebilir kardiyoverter-defibrilatör yerleştirilmesi gibi birçok mekanizma önerilmiştir. Karmaşık anatomisi nedeniyle brakial pleksus yaralanmasının teşhisi zordur. Klinik değerlendirme, manyetik rezonans görüntüleme, özellikle yüksek çözünürlüklü 3T manyetik rezonans nörografi, elektronöromiyografi ve somatosensöriyel uyarılmış potansiyel monitörizasyonu, brakial pleksus yaralanmasının tanısında faydalı yöntemler olarak kabul edilmektedir. Brakiyal pleksus yaralanmasının önlenmesi ve azaltılması için tam sternal retraksiyon, sabit ve asimetrik traksiyonun önlenmesi, cerrahi sırasında eller yukarı pozisyonu ve internal meme arterinin hazırlanmasında uygun olmayan sternal retraksiyondan kaçınma dâhil olmak üzere çeşitli stratejiler önerilmektedir. Bu derleme, kalp cerrahisi sonrası brakial pleksus hasarının oluşumunu, mekanizmalarını, tanısal ve önleyici ölçümlerini değerlendirmektedir

Anahtar Kelimeler: Brakial pleksus yaralanması; kalp ameliyatı; nörolojik yaralanma
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