Diaphragmatic hernias are a known complication of explanting a left ventricular assist device. The increasing use of left ventricular assist devices has resulted in an increased risk of this complication. We present the case of a patient who presented with diaphragmatic hernias on routine follow-up after a heart transplant. A left thoracotomy was performed to expose and reduce the hernia using a bovine pericardial patch to repair the defect. This biomaterial represents a viable alternative to traditional GORE-TEX patches with the probability of decreased infectious complications.

Normal subjects preserve tidal volume (VT) in the face of added inspiratory resistance by increasing maximal amplitude and duration of the rising phase of respiratory driving pressure (DP) and by changing the shape of this phase to one that is more concave to the time axis. To explore the possible role of chest wall afferents in mediating these responses, we determined averaged DP in eight quadriplegic subjects during steady-state unloaded breathing and while breathing through an inspiratory resistance (8.5 cmH2O X 1(-1) X s). As with normal subjects, quadriplegics preserved VT (loaded VT = 106% control) by utilizing all three mechanisms. However, prolongation of the inspiratory duration derived from the DP waveform (+22% vs. +42%) and shape response were significantly less in the quadriplegic subjects. Shape response was completely absent in subjects with C4 lesions. The results provide strong evidence that respiratory muscle spindles are responsible for shape response and that changes in afferent feedback from the chest wall play an important role in mediating inspiratory prolongation.