Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea.
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 1s (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).


CONCLUSIONS
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.
Department of Cardio-thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. m.i.m.versteegh@lumc.nl
Michel I M
MI
Versteegh
Jerry
J
Braun
Pieter G
PG
Voigt
Daniël B
DB
Bosman
Jan
J
Stolk
Klaus F
KF
Rabe
Robert A E
RA
Dion
D000368:Aged; D000369:Aged, 80 and over; D003964:Diaphragm / Q000601:surgery*; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012129:Respiratory Function Tests / Q000379:methods; D012133:Respiratory Paralysis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D019616:Thoracic Surgical Procedures / Q000379:methods; D016896:Treatment Outcome