Diaphragmmatic eventration: long-term follow-up and results of open-chest plicature.
OBJECTIVE
Diaphragmmatic eventration is a relatively uncommon entity with a simple surgical correction technique--plication of the diaphragm. This study aims to assess the clinical and ventilatory impact of this technique.


METHODS
From April 1988 to February 2007, we operated on 20 patients (12 men) with diaphragmmatic eventration using the postero-lateral approach and correction by radial plication. The mean age of the patients studied was 56.3+/-15.6 years (range: 13-74 years). A traumatic cause was identified in 13 patients; one patient had a congenital cause and the remainder were of idiopathic origin. Chronic obstructive pulmonary disease and arterial hypertension were present in one-half of the study group, while diabetes mellitus was present in three patients. Dyspnoea was the most common complaint in 75% of the patients, and thoracic pain was present in 25%. The mean forced expiratory volume in 1 s (FEV(1)) and vital capacity (VC) were 66.2+/-15.3% and 70.4+/-16% of the predicted values, respectively.


RESULTS
There was no operative mortality. Apart from a patient with moderate/severe pain and another who had pneumonia, there were no other important perioperative complications. Average drainage time was 3.3+/-1.6 days (range: 2-7 days). Hospitalisation time was 6.2+/-1.6 days (5-10 days). Follow-up was complete, for a mean of 59.6+/-55.1 months (4-206 months). There were three late deaths (one sudden, one stroke and one trauma). Eight of the 17 survivors (47%) are asymptomatic. According to the MRC/ATS grading system, the dyspnoea score was 2.06+/-0.97 preoperatively and 1.06+/-1.14 postoperatively (p=0.007). At follow-up, the FEV(1) was 76.1+/-20.1% and the VC was 78.4+/-17.3% (p>0.1). Two patients had chronic pain.


CONCLUSIONS
Plication of the diaphragm is a safe and efficient procedure. Most patients experienced significant clinical improvement with enhancement of the FEV(1) and VC. Chronic surgical pain still remains a potential problem with the classical approach.
Calvinho
Paulo
P
Cardiothoracic Surgery, University Hospital, 3000-075 Coimbra, Portugal.
Bastos
Cláudia
C
Bernardo
João E
JE
Eugénio
Luís
L
Antunes
Manuel J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D003964:Diaphragm / Q000002:abnormalities / Q000293:injuries / Q000601:surgery*; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012133:Respiratory Paralysis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D014797:Vital Capacity