title: Effects of diaphragm plication on pulmonary function and cardiopulmonary exercise parameters.
abstract: OBJECTIVE
  Paralysis of the diaphragm is an uncommon condition, which may result in dyspnoea on excertion and in orthopnea. In patients who have symptoms, the paralysed diaphragm is often plicated to prevent its paradoxical movement on inspiration. This procedure brings relief to many patients, but the mechanism for this improvement is not well understood.
  
  
  METHODS
  Nine symptomatic patients who underwent plication of a unilateral paralysed hemidiaphragm were prospectively evaluated. All patients underwent pulmonary function tests and cardiopulmonary exercise tests before surgery and repeated them after surgery.
  
  
  RESULTS
  Patients with hemidiaphragm paralysis before surgery were found to have lower tidal volumes at any given ventilation rate during exercise than normal subjects. A clear and consistent change was found in the manner in which patients increased their ventilation during exercise after surgery. All patients showed an increase in tidal volume for a given ventilation rate, which was significant. The plication procedure reduced the respiratory rate for any exercise level in all patients, and this effect was more pronounced during exercise.
  
  
  CONCLUSIONS
  In patients with hemidiaphragm paralysis who underwent a diaphragm plication exercise, tidal volumes increased and the ventilatory frequency decreased. Despite this improvement, maximal exercise capacity remained unaltered.
authors: Department of Surgery, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, Netherlands.
authors: Willem N
authors: WN
authors: Welvaart
authors: Patrick M C
authors: PM
authors: Jak
authors: Mariëlle C
authors: MC
authors: van de Veerdonk
authors: Johannes T
authors: JT
authors: Marcus
authors: Coen A C
authors: CA
authors: Ottenheijm
authors: Marinus A
authors: MA
authors: Paul
authors: Anton
authors: A
authors: Vonk Noordegraaf
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003964:Diaphragm / Q000503:physiopathology* / Q000601:surgery*; D004417:Dyspnea / Q000503:physiopathology; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012133:Respiratory Paralysis / Q000503:physiopathology* / Q000601:surgery*; D012143:Respiratory Physiological Phenomena
keywords: Cardiopulmonary exercise tests; Diaphragm; Dyspnoea; Paralysis