Patient Develops Diaphragm Paralysis Following Cardiothoracic Surgery

This case involves a 44-year-old male patient with a history of arthritis who developed a small, benign germ cell tumor in his chest. Following the surgical removal of the tumor, the patient experienced severe bilateral diaphragm paralysis. The patient required several diaphragm plication surgeries to correct this. In spite of the correctional surgeries, the patient could not breathe on his own and was put on permanent ventilation. An expert in cardiothoracic surgery was sought to review the records and opine on surgical technique, causation of paralysis, liability for subsequent ventilation, and the general standard of care for patients under these conditions.

Question(s) For Expert Witness

1. Please explain your background in cardiothoracic surgery.

2. Do you routinely remove mediastinal masses?

3. What precautions are taken to avoid diaphragm paralysis?

Expert Witness Response E-051990

I am an assistant professor of cardiothoracic surgery and an associate program director of the cardiothoracic surgery unit. I do remove mediastinal masses and I am very familiar with those operations, but I wouldn't say they are routine operations. Understanding anatomy is the number one precaution that can be taken to avoid diaphragm paralysis, as well as not giving the patient paralytics prior or during anesthesia. Based on the information I have received, this seems to be an injury to the phrenic nerve that caused paralysis of the diaphragm.

Expert Bio

This expert cardiothoracic surgeon serves in senior administrative roles for a major medical center in southern California. He is a member of numerous professional societies and has published multiple articles in peer-reviewed journals. Currently, he serves as attending staff at several regional hospitals in southern California, and as an assistant professor of cardiothoracic surgery and associate program director of cardiothoracic surgery for a regional medical school. In addition, the expert currently serves as director of the cardiothoracic ICU, chief of cardiothoracic surgery, and director of the aortic center for a top university-affiliated medical center in Los Angeles.