Boussuges M, Blanc P, Bregeon F, Boussuges A. Interest of thoracic ultrasound after cardiac surgery or interventional cardiology. World J Cardiol 2024; 16(3): 118-125 [PMID: 38576518 DOI: 10.4330/wjc.v16.i3.118]
Corresponding Author of This Article
Alain Boussuges, MD, PhD, Professor, Center for Cardiovascular and Nutrition Research, Aix Marseille Université, Faculté des Sciences Médicales et Paramédicales, 27 bd Jean Moulin, Marseille 13005, France. alain.boussuges@univ-amu.fr
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Mar 26, 2024; 16(3): 118-125 Published online Mar 26, 2024. doi: 10.4330/wjc.v16.i3.118
Interest of thoracic ultrasound after cardiac surgery or interventional cardiology
Martin Boussuges, Philippe Blanc, Fabienne Bregeon, Alain Boussuges
Martin Boussuges, Service de Pneumologie, Centre Hospitalier Universitaire Sud Reunion, Saint Pierre 97410, Ile de la Reunion, France
Philippe Blanc, Department of Cardiac and Pulmonary Rehabilitation, Ste Clotilde & YlangYlang Rehabilitation Center, Sainte Clotilde 97491, Ile de la Reunion, France
Fabienne Bregeon, Alain Boussuges, Service d’Explorations Fonctionnelles Respiratoires, Centre Hospitalier Universitaire Nord, Assistance Publique des Hôpitaux de Marseille, Marseille 13015, France
Alain Boussuges, Center for Cardiovascular and Nutrition Research, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, Marseille 13005, France
Author contributions: The article project was designed by Boussuges A; Boussuges M, Blanc P, Bregeon F, and Boussuges A contributed equally to the article by conducting a literature review, drafting the article, making critical revisions and approving the final version.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alain Boussuges, MD, PhD, Professor, Center for Cardiovascular and Nutrition Research, Aix Marseille Université, Faculté des Sciences Médicales et Paramédicales, 27 bd Jean Moulin, Marseille 13005, France. alain.boussuges@univ-amu.fr
Received: December 22, 2023 Peer-review started: December 22, 2023 First decision: January 17, 2024 Revised: January 19, 2024 Accepted: February 20, 2024 Article in press: February 20, 2024 Published online: March 26, 2024
Abstract
Thoracic ultrasound has attracted much interest in detecting pleural effusion or pulmonary consolidation after cardiac surgery. In 2016, Trovato reported, in the World Journal of Cardiology, the interest of using, in addition to echocardiography, thoracic ultrasound. In this editorial, we highlight the value of assessing diaphragm function after cardiac surgery and interventional cardiology procedures. Various factors are able to impair diaphragm function after such interventions. Diaphragm motion may be decreased by chest pain secondary to sternotomy, pleural effusion or impaired muscle function. Hemidiaphragmatic paralysis may be secondary to phrenic nerve damage complicating cardiac surgery or atrial fibrillation ablation. Diagnosis may be delayed. Indeed, respiratory troubles induced by diaphragm dysfunction are frequently attributed to pre-existing heart disease or pulmonary complications secondary to surgery. In addition, elevated hemidiaphragm secondary to diaphragm dysfunction is sometimes not observed on chest X-ray performed in supine position in the intensive care unit. Analysis of diaphragm function by ultrasound during the recovery period appears essential. Both hemidiaphragms can be studied by two complementary ultrasound methods. The mobility of each hemidiaphragms is measured by M-mode ultrasonography. In addition, recording the percentage of inspiratory thickening provides important information about the quality of muscle function. These two approaches make it possible to detect hemidiaphragm paralysis or dysfunction. Such a diagnosis is important because persistent diaphragm dysfunction after cardiac surgery has been shown to be associated with adverse respiratory outcome. Early respiratory physiotherapy is able to improve respiratory function through strengthening of the inspiratory muscles i.e. diaphragm and accessory inspiratory muscles.
Core Tip: Diaphragm dysfunction can be secondary to cardiac surgery or atrial fibrillation ablation via phrenic nerve injury. In patients with comorbidities such as obesity and cardiac or respiratory diseases, unilateral diaphragm paralysis may be poorly tolerated. Diaphragm ultrasound is the most appropriate tool for early diagnosis.
