title: Thoracoscopic plication for diaphragmatic eventration after surgery for congenital heart disease in children.
abstract: OBJECTIVE
  The aim of this study was to clarify the role of thoracoscopic plication for diaphragmatic eventration after surgery for congenital heart disease (CHD) in children.
  
  
  METHODS
  We retrospectively reviewed the medical charts of pediatric patients who had undergone thoracoscopic plication of diaphragmatic eventration after surgery for CHD between 2008 and 2013 at our department.
  
  
  RESULTS
  Five patients were identified during the study period. The median age and body weight of the patients were 7.6 months and 6.6 kg, respectively. The associated CHDs were pulmonary artery atresia in 3 patients, truncus arteriosus in 1 patient, and double-outlet right ventricle in 1 patient. Four patients needed preoperative mechanical respiratory support. At operation, all the patients received CO2 insufflation (4 mm Hg), and single-lung ventilation was attempted in 3 patients using a bronchial blocker. A sufficient operative field was maintained by CO2 insufflation in all the patients regardless of single-lung ventilation. The procedure was not converted to open operation in any patient. Postoperative extubation was performed in the operating room in 1 patient, on the day of operation in 2 patients, and on postoperative Days 1 and 2 in 2 patients. Air embolism was not observed in any of the patients. Diaphragmatic eventration did not recur in any of the patients after thoracoscopic plication.
  
  
  CONCLUSIONS
  Thoracoscopic plication is a safe and effective procedure for pediatric diaphragmatic eventration after surgery for CHD. Considering the sufficient operative field maintained by CO2 insufflation, single-lung ventilation using a bronchial blocker would be unnecessary for this procedure. With its safety and good outcome, early thoracoscopic plication is a good treatment option for pediatric patients with symptomatic diaphragmatic eventration after surgery for CHD.
authors.affiliation: Department of Pediatric Surgery, Faculty of Medicine, The University of Tokyo , Tokyo, Japan .
authors.forename: Jun
authors.initials: J
authors.lastname: Fujishiro
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ishimaru
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Mari
authors.initials: M
authors.lastname: Arai
authors.forename: Chizue
authors.initials: C
authors.lastname: Uotani
authors.forename: Mariko
authors.initials: M
authors.lastname: Yoshida
authors.forename: Kyohei
authors.initials: K
authors.lastname: Miyakawa
authors.forename: Tomo
authors.initials: T
authors.lastname: Kakihara
authors.forename: Tadashi
authors.initials: T
authors.lastname: Iwanaka
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D003964:Diaphragm / Q000601:surgery*; D003965:Diaphragmatic Eventration / Q000601:surgery*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome