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Original Articles: General Thoracic

Long-Term Follow-Up of the Functional and Physiologic Results of Diaphragm Plication in Adults With Unilateral Diaphragm Paralysis

Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana

Accepted for publication May 8, 2009.

^_* Address correspondence to Dr Freeman, 8433 Harcourt Rd, Indianapolis, IN 46260 (Email: rfreeman{at}corvascmds.com).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: Patients with lifestyle-limiting dyspnea attributable to unilateral diaphragm paralysis have been shown to experience a decrease in their dyspnea and an improvement in their pulmonary spirometry and functional status with diaphragm plication acutely after surgery. This investigation summarizes these patients' outcomes with long-term follow-up.

Methods: Adult patients undergoing plication of the hemidiaphragm for lifestyle-limiting dyspnea secondary to unilateral diaphragm paralysis were assessed preoperatively, 6 month after surgery and then annually using the Medical Research Council dyspnea score, pulmonary spirometry, activities of daily living questionnaire, and a chest radiograph. Patients with at least 48 months of follow-up were included in this investigation.

Results: Forty-one patients underwent plication of the hemidiaphragm through video-assisted thoracoscopy (30) or thoracotomy (11). Mean follow-up was 57 ± 10 months. Mean forced vital capacity, forced expiratory volume at 1 second, functional residual capacity, and total lung capacity all improved by 19%, 23%, 21%, and 19% (p < 0.005), respectively, when measured 6 months after surgery, as were mean Medical Research Council dyspnea scores (p < 0.0001). These mean values remained constant over the follow-up period. Four patients did not show improvement in their Medical Research Council dyspnea scores nor functional status despite improvements in their pulmonary spirometry values. Two of these patients had a body mass index greater than 35 kg/m² and 3 had documented unilateral diaphragm paralysis for at least 4 years before plication.

Conclusions: Plication of the hemidiaphragm produces improvement for the vast majority of patients in pulmonary spirometry, dyspnea, and functional status that endures over long-term follow-up. Patients who are morbidly obese or who have longstanding unilateral diaphragm paralysis may not realize the same benefits of plication.

This article has been cited by other articles:

				S. S. Groth and R. S. Andrade Diaphragm Plication for Eventration or Paralysis: A Review of the Literature Ann. Thorac. Surg., June 1, 2010; 89(6): S2146 - S2150. [Abstract] [Full Text] [PDF]