| Title | Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis. | | Author(s) | Freeman RK, Van Woerkom J, Vyverberg A, Ascioti AJ | | Institution | Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana, USA. rfreeman@corvascmds.com | | Source | Ann Thorac Surg 2009 Oct; 88(4):1112-7. | | MeSH | Adult
Diaphragm
Female
Follow-Up Studies
Humans
Male
Middle Aged
Recovery of Function
Respiratory Function Tests
Respiratory Paralysis
Retrospective Studies
Thoracic Surgical Procedures
Time Factors
Treatment Outcome
| | Abstract | 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/m(2) 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. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
| | PubMed ID | 19766791 |
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