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

Abstract

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. #

Anesthesia Approach in a Patient with Hemidiphragma Paralysis: Case Report

“…Plikasyon yapılan olguların postoperatif solunum fonksiyon testlerinde anlamlı düzelme görülmüştür. (5) Diyafragma plikasyonu yapılarak akciğer ekspansiyonu kolaylıkla sağlanmakta-dır. (3) Plikasyon ameliyatı için yapılacak torakotomi büyük bir girişim olarak görülse de, günümüzde torakoskopik tekniklerde tanımlanmıştır.…”

“…(4) Bir diğer konjenital hastalığa bağlı olarak gelişen diyafragma evantrasyonu ile karıştırılma-malıdır. (5) Bu olgu sunumunda, preoperatif dönem-de semptomları olmayan unilateral diyafragma paralizili bir hastada oluşabilecek olası zorlukların önlenmesi, gelişebilecek komplikasyonların tanınması ve sonucunda yapılabilecek tedavilerin tartışılması amaçlanmıştır.…”

Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management

“…We believe the number of suture layers is not critical because it is more important that the degree of plication or "diaphragm tautness" should be not as tight as possible or tense when palpated [1,11] or form a flattened dome (Leo et al [12]), but should be sufficient for complete intra-operation re-expansion of the left pulmonary artery.…”

Unilateral Diaphragmatic Paralysis in a Diabetic Patient: A Case of Trepopnea

“…There were three deaths due to an acute coronary events, pulmonary embolism, and right heart failure. These were likely not related to the surgical intervention itself 24 . The long-term prognosis of unilateral diaphragmatic paralysis is excellent except in patients with an underlying lung disease.…”

“…As for the medical treatment, one case report described successful use of topiramate as treatment of diabetic phrenic nerve palsy 13 . CPAP may be used to prevent ventilatory failure in patients with bilateral paralysis, in pediatric patients and as a bridge for patients waiting for surgical correction 24,25 .…”