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Tracing The Right Phrenic Nerve - A Systematic Review And Meta-Analysis

Background:The Right phrenic nerve (RPN) is vulnerable to injury during the isolation of the right pulmonary veins (RPV). The study aimed to provide a comprehensive meta-analysis of the overall prevalence of right phrenic nerve injury (RPNI), its course and its association with the superior and inferior pulmonary veins. Methods: Through December 2017, a database search was performed on PubMed, Science Direct, EMBASE, SciELO, and Web of Science. The references were also extensively searched in the included articles. Results: Detection of the RPN may vary according to the identification method. It ranges From from 100% in postmortem studies, 93% in intraoperative, to 57.88% in computer tomography (CT) imaging. From all Based on the included studies (n-507), the distance from the right superior pulmonary vein (RSPV) ostium to the RPN was 12.48mm (6.21). In postmortem studies, the distance was 6.92mm (3.94); in pre or intraoperative techniques, 13.32mm (5.96) if noninvasive, 13.97mm (7.8) if invasive. Distances ranged from 0–42.6 mm. For the right inferior pulmonary vein (RIPV) (n-125) the mean distance was 16.53mm (8.92) with distances from 0.4 – 68mm. The risk of RPNI with distance-included studies was 12.46% (47 RPNI in 377 cases). In the meta-analysis, the distance from the RSPV to the RPN that was associated with an increased risk of RPNI was 7.36mm. Conclusion:RPNI is a relatively rare complication. A firm understanding of its course, relation to the PV ostium, and detection are vital for preventing future injuries and complications.

Credits: Kuniewicz M, Mazur M , Karkowski G , Budnicka K, Przybycie? W , Walocha J , Lelakowski J

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