title: Long-term results of diaphragmatic plication in adults with unilateral diaphragm paralysis.
abstract: BACKGROUND
  In this study we aimed to evaluate the long-term outcome of diaphragmatic plication for symptomatic unilateral diaphragm paralysis.
  
  
  METHODS
  Thirteen patients who underwent unilateral diaphragmatic plication (2 patients had right, 11 left plication) between January 2003 and December 2006 were evaluated. One patient died postoperatively due to sepsis. The remaining 12 patients [9 males, 3 females; mean age 60 (36-66) years] were reevaluated with chest radiography, flouroscopy or ultrasonography, pulmonary function tests, computed tomography (CT) or magnetic resonance imaging (MRI), and the MRC/ATS dyspnea score at an average of 5.4 (4-7) years after diaphragmatic plication.
  
  
  RESULTS
  The etiology of paralysis was trauma (9 patients), cardiac by pass surgery (3 patients), and idiopathic (1 patient). The principle symptom was progressive dyspnea with a mean duration of 32.9 (22-60) months before surgery. All patients had an elevated hemidiaphragm and paradoxical movement radiologically prior to surgery. There were partial atelectasis and reccurent infection of the lower lobe in the affected side on CT in 9 patients. Atelectasis was completely improved in 9 patients after plication. Preoperative spirometry showed a clear restrictive pattern. Mean preoperative FVC was 56.7 ± 11.6% and FEV1 65.3 ± 8.7%. FVC and FEV1 improved by 43.6 ± 30.6% (p < 0.001) and 27.3 ± 10.9% (p < 0.001) at late follow-up. MRC/ATS dyspnea scores improved 3 points in 11 patients and 1 point in 1 patient at long-term (p < 0.0001). Eight patients had returned to work at 3 months after surgery.
  
  
  CONCLUSIONS
  Diaphragmatic plication for unilateral diaphragm paralysis decreases lung compression, ensures remission of symptoms, and improves quality of life in long-term period.
authors.affiliation: Siyami Ersek Cardiothoracic Training Hospital, Thoracic Surgery Department, Istanbul, Turkey. siyamie@gmail.com
authors.forename: Sezai
authors.initials: S
authors.lastname: Celik
authors.forename: Muharrem
authors.initials: M
authors.lastname: Celik
authors.forename: Bulent
authors.initials: B
authors.lastname: Aydemir
authors.forename: Cemalettin
authors.initials: C
authors.lastname: Tunckaya
authors.forename: Tamer
authors.initials: T
authors.lastname: Okay
authors.forename: Ilgaz
authors.initials: I
authors.lastname: Dogusoy
mesh_terms: D000328:Adult; D003964:Diaphragm / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D012133:Respiratory Paralysis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity