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Eur J Cardiothorac Surg 2002;21:294-297
© 2002 Elsevier Science NL

Long term results of diaphragmatic plication for unilateral diaphragm paralysis

^a Royal Devon and Exeter NHS Trust, Barrack Road, Exeter, Devon EX2 5DW, UK
^b The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK

Received 21 November 2000; received in revised form 7 September 2001; accepted 20 November 2001.

* Corresponding author. Tel.:+44-1392-402-177; fax: +44-1392-402-067
e-mail: richard.berrisford{at}rdehc-tr.swest.nhs.uk

Objectives: To examine whether diaphragmatic plication is an effective and lasting treatment option for non-malignant diaphragmatic paralysis. Methods: Nineteen patients who had undergone diaphragm plication (1983–1990) were recalled for interview, pulmonary function testing and chest X-ray. Results: There were 13 men and six women aged 24–73 (mean 55). Diaphragm paralysis was idiopathic (n=9), postsurgical (n=3), related to cervical spondylosis (n=4) and neck injury (n=2). Patients presented with breathlessness (18/19) or orthopnoea (1/19). Symptoms had lasted 3–60 months (mean 24 months). All patients had a raised hemidiaphragm on chest X-ray with paradoxical movement on ultrasound. Mean preoperative FVC was 71% predicted (range 38–93, SD 12.9) and mean FEV₁ was 67% predicted (range 33–90, SD 10.8). Supine lung volumes were 81% (mean) of sitting values. There were six right plications and 13 left. There were no postoperative deaths. One patient required re-plication. Follow-up (18/19 of original operated patients) ranged from 7–14 years (mean 10 years). Three patients had died of unrelated causes and one patient failed to attend long term follow-up, leaving 15 patients of the original 19 operated on. Positional change in lung volumes was not affected by surgery at early (6 week) or late (>5 year) follow-up. FVC, FEV₁, FRC and TLC improved by 10.1*, 11.8*, 16.9* and 9.2*%, respectively, at early follow-up and 11.8*, 15.4*, 26 and 13.3*% at late follow-up (*P<0.005 signed rank). Dyspnoea scores at long term follow-up improved 1 point (n=5), 2 points (n=5) and 3 points (n=2), remained unchanged (n=1) or dropped 1 point (n=2). Of the 15 patients followed up all but one who had been employed returned to work. 14/15 patients expressed satisfaction with their surgery. Conclusion: Diaphragm plication is an effective procedure with lasting results.

Key Words: Diaphragmatic paralysis • Diaphragmatic plication • Thoracic surgery • Long term follow-up

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