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Ann Thorac Surg 1982;33:184-188
© 1982 The Society of Thoracic Surgeons

Articles

Diaphragmatic Paralysis Managed by Diaphragmatic Replacement

Thomas E. Bowen, M.D., Col*, Russ Zajtchuk, M.D., Col, Robert A. Albus, M.D., Lt Col, All MC, USA

From the Thoracic and Cardiovascular Surgical Service, Department of Surgery, Letterman Army Medical Center, Presidio of San Francisco, CA, and the Uniformed Services, University of Health Sciences, Department of Surgery, Bethesda, MD

Accepted for publication January 22, 1981.

* Address reprint requests to Dr. Bowen, Chief Professional Services, USA MEDDAC, Panama, APO Miami, FL 34004

A neonate had paralysis of the right hemidiaphragm secondary to brachial plexus birth trauma. Conventional diaphragmatic plication, performed on two separate occasions, failed to correct the ventilatory impairment, and mechanical ventilatory dependence persisted. Ventilatory insufficiency was subsequently corrected by total replacement of the right hemidiaphragm with Marlex mesh. This procedure ablated paradoxical motion of the right hemidiaphragm and arrested detrimental shifts of the mobile infantile mediastinum. The good result was immediate and long-lasting; there was no major prosthesis-related growth deformity 31/2 years later. Prosthetic fixation of the paralyzed diaphragm is not indicated as a primary procedure, but should be reserved for the occasional patient in whom conventional plication has failed.




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D A Simansky, M Paley, Y Refaely, and A Yellin
Diaphragm plication following phrenic nerve injury: a comparison of paediatric and adult patients
Thorax, July 1, 2002; 57(7): 613 - 616.
[Abstract] [Full Text] [PDF]


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