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The Annals of Thoracic Surgery, Vol 49, 248-251, Copyright © 1990 by The Society of Thoracic Surgeons
DR Graham, D Kaplan, CC Evans, CR Hind and RJ Donnelly
Unilateral paralysis of the diaphragm due to nonmalignant disease is an
uncommon disorder previously thought to have benign implications. Some
patients, however, experience dyspnea and orthopnea with impairment of
pulmonary function. Unilateral diaphragmatic plication was performed on 17
patients (16 men and 1 woman with a mean age of 53.7 years [range, 28 to 74
years]) during the last 10 years. Preoperatively each patient was shown to
have paradoxical movement of the paralyzed diaphragm on sniffing and to
have a reduction in forced vital capacity and lung volumes. These
reductions were greater when the patient was in the supine position. All
patients had moderate hypoxemia (mean arterial oxygen tension, 73.1 +/-
10.9 mm Hg). Plication was performed by imbricating the diaphragm in layers
through a thoracotomy incision. After plication, all patients showed both
subjective and objective improvement. Six patients were reassessed 5 or
more years after plication (range, 5 to 7 years), and the improvement was
maintained. Diaphragmatic plication is a safe and effective procedure for
adult patients with dyspnea due to unilateral diaphragmatic paralysis;
furthermore, the initial improvement is maintained.
ARTICLES
Diaphragmatic plication for unilateral diaphragmatic paralysis: a 10- year experience
Regional Adult Cardiothoracic Unit, Broadgreen Hospital, Liverpool, United Kingdom.
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