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Robert A.E. Dion
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Eur J Cardiothorac Surg 2007;32:449-456. doi:10.1016/j.ejcts.2007.05.031
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea

Michel I.M. Versteegha,*, Jerry Brauna, Pieter G. Voigta, Daniël B. Bosmana, Jan Stolkb, Klaus F. Rabeb, Robert A.E. Diona

a Department of Cardio-thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
b Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands

Received 2 February 2007; received in revised form 8 May 2007; accepted 23 May 2007.

* Corresponding author. Address: Leiden University Medical Center, Department of Cardio-thoracic Surgery, K6-S, P.O. Box 9600, 2300 RC Leiden, The Netherlands. Tel.: +31 71 5262355; fax: +31 71 5266359. (Email: m.i.m.versteegh{at}lumc.nl).

Objective: There is still controversy about the feasibility and long-term outcome of surgical treatment of acquired diaphragm paralysis. We analyzed the long-term effects on pulmonary function and level of dyspnea after unilateral or bilateral diaphragm plication. Methods: Between December 1996 and January 2006, 22 consecutive patients underwent diaphragm plication. Before surgery, spirometry in both seated and supine positions and a Baseline Dyspnea Index were assessed. The uncut diaphragm was plicated as tight as possible through a limited lateral thoracotomy. Patients with a follow-up exceeding 1 year (n = 17) were invited for repeat spirometry and assessment of changes in dyspnea level using the Transition Dyspnea Index (TDI). Results: Mean follow-up was 4.9 years (range 1.2–8.7). All spirometry variables showed significant improvement. Mean vital capacity (VC) in seated position improved from 70% (of predicted value) to 79% (p < 00.03), and in supine position from 54% to 73% (p = 0.03). Forced expiratory volume in 1 s (FEV1) in supine position improved from 45% to 63% (p = 0.02). Before surgery the mean decline in VC changing from seated to supine position was 32%. At follow-up this had improved to 9% (p = 0.004). For FEV1 these values were 35% and 17%, respectively (p < 0.02). TDI showed remarkable improvement of dyspnea (mean + 5.69 points on a scale of –9 to +9). Conclusion: Diaphragm plication for single- or double-sided diaphragm paralysis provides excellent long-term results. Most patients were severely disabled before surgery but could return to a more or less normal way of life afterwards.

Key Words: Diaphragm plication • Diaphragm paralysis • Phrenic nerve dysfunction • Surgical treatment of dyspnea




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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.