title: Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis.
abstract: BACKGROUND
  Patients with lifestyle-limiting dyspnea attributable to unilateral diaphragm paralysis have been shown to experience a decrease in their dyspnea and an improvement in their pulmonary spirometry and functional status with diaphragm plication acutely after surgery. This investigation summarizes these patients' outcomes with long-term follow-up.
  
  
  METHODS
  Adult patients undergoing plication of the hemidiaphragm for lifestyle-limiting dyspnea secondary to unilateral diaphragm paralysis were assessed preoperatively, 6 month after surgery and then annually using the Medical Research Council dyspnea score, pulmonary spirometry, activities of daily living questionnaire, and a chest radiograph. Patients with at least 48 months of follow-up were included in this investigation.
  
  
  RESULTS
  Forty-one patients underwent plication of the hemidiaphragm through video-assisted thoracoscopy (30) or thoracotomy (11). Mean follow-up was 57 +/- 10 months. Mean forced vital capacity, forced expiratory volume at 1 second, functional residual capacity, and total lung capacity all improved by 19%, 23%, 21%, and 19% (p < 0.005), respectively, when measured 6 months after surgery, as were mean Medical Research Council dyspnea scores (p < 0.0001). These mean values remained constant over the follow-up period. Four patients did not show improvement in their Medical Research Council dyspnea scores nor functional status despite improvements in their pulmonary spirometry values. Two of these patients had a body mass index greater than 35 kg/m(2) and 3 had documented unilateral diaphragm paralysis for at least 4 years before plication.
  
  
  CONCLUSIONS
  Plication of the hemidiaphragm produces improvement for the vast majority of patients in pulmonary spirometry, dyspnea, and functional status that endures over long-term follow-up. Patients who are morbidly obese or who have longstanding unilateral diaphragm paralysis may not realize the same benefits of plication.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana, USA. rfreeman@corvascmds.com
authors.forename: Richard K
authors.initials: RK
authors.lastname: Freeman
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Van Woerkom
authors.forename: Amy
authors.initials: A
authors.lastname: Vyverberg
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Ascioti
mesh_terms: D000328:Adult; D003964:Diaphragm / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D012129:Respiratory Function Tests; D012133:Respiratory Paralysis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome