HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Richard K. Freeman Thomas C. Wozniak Edward B. Fitzgerald Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Freeman, R. K. Articles by Fitzgerald, E. B. Search for Related Content PubMed PubMed Citation Articles by Freeman, R. K. Articles by Fitzgerald, E. B. Related Collections Diaphragm

Ann Thorac Surg 2006;81:1853-1857
© 2006 The Society of Thoracic Surgeons

---

Original article: General thoracic

Functional and Physiologic Results of Video-Assisted Thoracoscopic Diaphragm Plication in Adult Patients With Unilateral Diaphragm Paralysis

^a Department of Thoracic and Cardiovascular Surgery, St. Vincent Hospital, Indianapolis, Indiana
^b Department of Thoracic and Cardiovascular Surgery, Methodist Hospital, Indianapolis, Indiana

Accepted for publication November 22, 2005.

^_* Address correspondence to Dr Freeman, 8433 Harcourt Rd, Suite 100, Indianapolis, IN 46260 (Email: rfreeman{at}corvascmds.com).

Presented at the Fifty-first Annual Meeting of the Southern Thoracic Surgical Association, Cancun, Mexico, Nov 2–4, 2004.

BACKGROUND: Plication of the hemidiaphragm for unilateral diaphragm paralysis is infrequently performed in adults. Barriers to diaphragm plication have included the perceived need for thoracotomy and uncertainty of the potential benefits. The purpose of this investigation was to assess the effects of video-assisted thoracoscopic diaphragm plication in symptomatic adult patients with unilateral diaphragm paralysis.

METHODS: Patients with unilateral diaphragm paralysis underwent an evaluation that included a chest radiograph, fluoroscopic sniff test, pulmonary spirometry, and the Medical Research Council (MRC) dyspnea score. Patients with symptomatic unilateral diaphragm paralysis present for at least 6 months were offered video-assisted thoracoscopic diaphragm plication. Patients who underwent diaphragm plication as well as those who declined surgery were reassessed at 6 months with a chest radiograph, spirometry, and the MRC dyspnea score.

RESULTS: Twenty-five patients underwent left (19) or right (6) diaphragm plication through video-assisted thoracoscopic diaphragm plication (22) or thoracotomy (3). There were no operative deaths. Mean hospital length of stay for diaphragm plication was 3.7 days for video-assisted thoracoscopic diaphragm plication and 5.4 days for thoracotomy. After diaphragm plication, mean forced vital capacity, forced expiratory volume at 1 second, functional residual capacity, and total lung capacity improved by 17%, 21.4%, 20.3%, and 16.1%, respectively (p < 005) at 6 months. Mean MRC dyspnea scores also significantly improved in the operative cohort (p < 0001). Seventeen patients in the surgical cohort had returned to work at 6 months. Seven patients treated without surgery displayed a trend toward more frequent hospitalizations and deteriorating pulmonary spirometry and MRC dyspnea scores during the follow-up period.

CONCLUSIONS: Plication of the hemidiaphragm using minimally invasive techniques produced significant improvements in patients' functional status, pulmonary spirometry, and MRC dyspnea scores. Video-assisted thoracoscopic diaphragm plication should be considered appropriate therapy in symptomatic adult patients with unilateral diaphragm paralysis.

This article has been cited by other articles:

				M. I. M. Versteegh and A. T. Jouk Tjien Diaphragm plication in adult patients with diaphragm paralysis MMCTS, December 17, 2007; 2007(1217): 2568. [Abstract] [Full Text] [PDF]

				M. I.M. Versteegh, J. Braun, P. G. Voigt, D. B. Bosman, J. Stolk, K. F. Rabe, and R. A.E. Dion Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 449 - 456. [Abstract] [Full Text] [PDF]