Long term results of diaphragmatic plication for unilateral diaphragm paralysis

Higgs, Simon; Hussain, Afzal; Jackson, Mark; Donnelly, R. J.; Berrisford, Richard

doi:10.1016/s1010-7940(01)01107-1

Cited by 103 publications

(56 citation statements)

References 8 publications

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“…10 Despite the promising results for both short-term and long-term outcomes, precise selection of suitable patients is necessary. 10,11 This case report demonstrates the potential of FRI as a new functional imaging technique in respiratory medicine to choose the right treatment plan in patients with idiopathic unilateral diaphragmatic paralysis. In both patients, radiologic examination revealed the appearance of atelectasis in the lower lobes.…”

Section: Discussionmentioning

confidence: 82%

Functional Respiratory Imaging as a Tool to Personalize Respiratory Treatment in Patients With Unilateral Diaphragmatic Paralysis

Holsbeke

Leemans²,

Vos

et al. 2013

Respir Care

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A completely different treatment approach was chosen for 2 patients with unilateral diaphragmatic paralysis and complaints of dyspnea despite similar anatomic and physiologic abnormalities. These decisions were supported by results obtained by functional respiratory imaging (FRI). FRI generated functional information on lobar ventilation and local drug deposition. In the first patient, some lobes were poorly ventilated, and drug deposition simulation showed that some regions were undertreated. This patient underwent diaphragmatic plication to restore ventilation. In the second patient, all lobes were still ventilated. A conservative approach with regular follow-ups was chosen to wait for spontaneous recovery of the diaphragmatic function. Both patients improved subjectively and objectively. These cases demonstrate how novel medical imaging techniques such as FRI can be used to personalize respiratory treatment in patients with unilateral diaphragmatic paralysis.

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Section: Discussionmentioning

confidence: 82%

Functional Respiratory Imaging as a Tool to Personalize Respiratory Treatment in Patients With Unilateral Diaphragmatic Paralysis

Holsbeke

Leemans²,

Vos

et al. 2013

Respir Care

View full text Add to dashboard Cite

show abstract

“…Surgical treatment of diaphragm paralysis by plication has been described since 1985 in small series for unilateral paralysis [13][14][15][16][17]20,21] and in three patients with bilateral paralysis [18]. Some studies only or mainly concern patients after cardiac surgery with problems at weaning from ventilation [16,22].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment by diaphragm plication has been described since 1985 in small series for unilateral paralysis [13][14][15][16][17] and in three patients with bilateral paralysis [18]. There is still controversy around this treatment, especially regarding its long-term outcome.…”

Section: Introductionmentioning

confidence: 99%

Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea

Versteegh

Braun

Voigt

et al. 2007

European Journal of Cardio-Thoracic Surgery

118

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Objective: There is still controversy about the feasibility and long-term outcome of surgical treatment of acquired diaphragm paralysis. We analyzed the long-term effects on pulmonary function and level of dyspnea after unilateral or bilateral diaphragm plication. Methods: Between December 1996 and January 2006, 22 consecutive patients underwent diaphragm plication. Before surgery, spirometry in both seated and supine positions and a Baseline Dyspnea Index were assessed. The uncut diaphragm was plicated as tight as possible through a limited lateral thoracotomy. Patients with a follow-up exceeding 1 year (n = 17) were invited for repeat spirometry and assessment of changes in dyspnea level using the Transition Dyspnea Index (TDI). Results: Mean follow-up was 4.9 years (range 1.2-8.7). All spirometry variables showed significant improvement. Mean vital capacity (VC) in seated position improved from 70% (of predicted value) to 79% ( p < 00.03), and in supine position from 54% to 73% ( p = 0.03). Forced expiratory volume in 1 s (FEV 1 ) in supine position improved from 45% to 63% ( p = 0.02). Before surgery the mean decline in VC changing from seated to supine position was 32%. At follow-up this had improved to 9% ( p = 0.004). For FEV 1 these values were 35% and 17%, respectively ( p < 0.02). TDI showed remarkable improvement of dyspnea (mean + 5.69 points on a scale of À9 to +9). Conclusion: Diaphragm plication for single-or double-sided diaphragm paralysis provides excellent long-term results. Most patients were severely disabled before surgery but could return to a more or less normal way of life afterwards. #

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“…Daily activities and dyspnea have also been improved (Versteege et al, 2007;Freeman et al, 2009). However, this degree of improvement has not been consistently found (Higgs et al, 2002). Data on the effect of diaphragmatic plication on exercise tolerance, on peak exercise and on exercise gas exchange are anecdotal, in the adult as in the pediatric population.…”

Section: Diaphragmatic Plicationmentioning

confidence: 98%