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The Annals of Thoracic Surgery, Vol 33, 184-188, Copyright © 1982 by The Society of Thoracic Surgeons
TE Bowen, R Zajtchuk and RA Albus
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.
ARTICLES
Diaphragmatic paralysis managed by diaphragmatic replacement
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