Unilateral Diaphragmatic Palsy After CABG

It had been a hefty day. I had kept myself busy for a presentation. Had not written anything for my blog. Was looking for an interesting case to kick my inner sense.

Just to engage myself in activities, I took my iPhone in my hand. Opened Facebook followed by WhatsApp as it peeped new messages. Our all-india CTVS thread..


Somebody has sent an X -ray image and an adding question below it. I clicked the image, but it started downloading. How X ray can be in video, i thought to myself. It was still downloading. Reliance Jio was doing its job. I was eager to answer, but already two doctors has answered back. I knew i was late, as always. It took 30 seconds to be downloaded but no time to open.

It was not an X Ray. Wow, flouroscopy? I was sure! But was querying myself, can X Ray images be taken in video format. It took me some minutes to clear it out… Flouroscopy is a version of X Ray in succession.

I have never seen something like that. It has been a long time we used to do X Ray and diagnose it to be collapse or effusion or eventuation. But what flouroscopy showed was lively. I uploaded the video to my youtube site to show it here in my blog.

Long time had passed to my training as a cardiac surgeon but it was a new eye opener.

Somebody had answered, “Right diaphragmatic palsy following phrenic nerve palsy while harvesting RIMA.”

I had no other answer to give. The fluoroscopy was clear, Sternum was shown as \ wrapped in stainless steel wires. Before I wrote something the doctor with the question replied a big thumbs up to the previous answer.

I queried, “How did you manage the case?” There was much expectation of response from the other

Got a reply a bit late but loved it the way he has answered with use of triball exercises.

“Triball Exercises” – wow, what a better way to present the simple look marvellous. Triball exercise is the spirometer with three balls we give to all cardiac surgery patients for breathing exercises.

After adequate visuals, I played the video once again and felt pleased.