Diaphragm plication following phrenic nerve injury: a comparison of paediatric and adult patients

Simansky, David; Paley, Martin; Refaely, Yael; Yellin, Alon

doi:10.1136/thorax.57.7.613

Cited by 87 publications

(62 citation statements)

References 28 publications

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“…Pulmonary function tests in upright and supine positions and a paradoxical diaphragm movement in a sniff-test using fluoroscopy or ultrasound confirm the diagnosis. Other suggested investigations [1,5,6,11] are not necessary and only add costs to the diagnostic route [1,12].…”

Section: Introductionmentioning

confidence: 99%

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

Versteegh

Braun

Voigt

et al. 2007

European Journal of Cardio-Thoracic Surgery

120

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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 (FEV 1 ) 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 FEV 1 these values were 35% and 17%, respectively ( p < 0.02). TDI showed remarkable improvement of dyspnea (mean + 5.69 points on a scale of À9 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. #

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Section: Introductionmentioning

confidence: 99%

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

Versteegh

Braun

Voigt

et al. 2007

European Journal of Cardio-Thoracic Surgery

120

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“…If supportive care is not sufficient and mechanical ventilation is prolonged, diaphragmatic plication may lead to rapid improvement. Some authors believe that plication, in the post trauma cases is in general more effective in neonate than in adults (Simansky et al, 2002).…”

Section: Diaphragmatic Paralysis In Neonatesmentioning

confidence: 99%

“…Furthermore, airflow from the affected lung to the normal lung minimizes, leading to improved ventilatory efficiency. Plication can be offered to selected, symptomatic patients, whose symptoms affect their life style (Simansky et al, 2002). The exact indications have not been established.…”

Section: Diaphragmatic Plicationmentioning

confidence: 99%

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Diaphragmatic Paralysis - Symptoms, Evaluation, Therapy and Outcome

Ben-Dov¹

2012

Congenital Diaphragmatic Hernia - Prenatal to Childhood Management and Outcomes

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“…However, the role of this procedure in adults is not clear as only isolated case reports or small series have been reported. [66][67][68][69] Phrenic nerve stimulators placed surgically can also be considered in rare cases. Diaphragmatic pacing is the stimulation of the phrenic nerves with electrical current via an implanted pacemaker, resulting in the contraction of the diaphragm.…”

Section: Diagnosismentioning

confidence: 99%

The Phrenic Nerve and Atrial Fibrillation Ablation Procedures

Asirvatham¹,

Mears²,

Lachman³

et al. 2009

J.A.F.I.B

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Radiofrequency ablation is increasingly used as an option to optimally manage patients with symptomatic atrial fibrillation. Presently, ablationists strive to improve success rates, particularly with persistent atrial fibrillation, while simultaneously attempting to reduce complications. A well-recognized complication with atrial fibrillation ablation is injury to the phrenic nerve giving rise to diaphragmatic paresis and patient discomfort.Phrenic nerve damage may occur when performing common components of atrial fibrillation ablation including pulmonary and superior vena caval isolation. The challenge for ablationists is to successfully target the arrhythmogenic substrate while avoiding this complication. In order to do this, a thorough knowledge of phrenic nerve anatomy, points in the ablation procedure where nerve damage is more likely, and an understanding of the presently utilized techniques to avoid this complication is required. In addition, when this complication does arise, prompt recognition of its occurrence, knowledge of the natural history, and available methods for management are needed.In this review, we discuss the underlying anatomic principles, techniques of avoiding phrenic nerve damage, and presently available methods of diagnosing and managing this complication.

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Diaphragm plication following phrenic nerve injury: a comparison of paediatric and adult patients

Cited by 87 publications

References 28 publications

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

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

Diaphragmatic Paralysis - Symptoms, Evaluation, Therapy and Outcome

The Phrenic Nerve and Atrial Fibrillation Ablation Procedures

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