HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Michel I.M. Versteegh Jerry Braun Pieter G. Voigt Robert A.E. Dion Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Versteegh, M. I.M. Articles by Dion, R. A.E. Search for Related Content PubMed PubMed Citation Articles by Versteegh, M. I.M. Articles by Dion, R. A.E. Related Collections Diaphragm

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

^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

This article has been cited by other articles:

				E. M. Summerhill, Y. A. El-Sameed, T. J. Glidden, and F. D. McCool Monitoring Recovery From Diaphragm Paralysis With Ultrasound Chest, March 1, 2008; 133(3): 737 - 743. [Abstract] [Full Text] [PDF]

				M. I. M. Versteegh and A. T. Jouk Tjien Diaphragm plication in adult patients with diaphragm paralysis MMCTS, December 17, 2007; 2007(1217): 2568. [Abstract] [Full Text] [PDF]