Chest
Clinical InvestigationsTHE PLEURALong-term Effect of Bilateral Plication of the Diaphragm
Section snippets
Study Subjects
Six patients who had isolated BDP caused by NA were assessed. The patient characteristics are presented in Table 1. All six patients had signs of right-sided heart failure. They were unable to lie flat and could sleep only while sitting in a chair. A neurologist found no signs of limb, neck, or thoracic muscle paralysis. Cervical magnetic stimulation and bilateral electrical stimulation of the phrenic nerves showed no activity in any of the patients. CT scans of the cervical and thoracic part
Results
The results of pulmonary function tests administered to patients at presentation in our clinic are shown in Table 1. The pulmonary artery pressures (mean ± SEM) were elevated in all six patients (systolic, 62 ± 15 mm Hg; diastolic, 46 ± 8 mm Hg). Patients 1 and 2 were the first patients in whom disease was diagnosed, and at that time we recommended only oxygen supplementation for relief of symptoms. Patient 3 (Table 1) refused the proposed operation. The three patients on whom surgery was
Discussion
Diaphragmatic paralysis producing symptoms in adults is an uncommon clinical problem, with sparse literature available about its treatment and long-term outcome. After observing the first two patients, who remained in poor clinical condition, we were particularly struck by the third patient (patient 4 in Table 1). This patient was a 47-year-old police officer who worked in active service on the street and who presented with signs of severe pulmonary hypertension that had developed in 2 weeks
ACKNOWLEDGMENT
The authors thank Dr. D. Koolbergen for the drawing of Figure 1.
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Cited by (35)
Phrenic Nerve Reconstruction and Bilateral Diaphragm Plication After Lobectomy
2017, Annals of Thoracic SurgeryCitation Excerpt :There is no known curative treatment for bilateral PNP and dysfunction of the diaphragm. Positive pressure ventilation, permanent ventilatory support, diaphragmatic pacing, and plication of the diaphragm have been used to treat respiratory failure caused by bilateral PNP [1]. Reconstruction of the injured nerve may be the only curative treatment option for PNP.
Sleep hypoventilation in neuromuscular and chest wall disorders
2014, Sleep Medicine ClinicsCitation Excerpt :The benefit of this surgery has been demonstrated to continue for more than 5 years. Many investigators suggest that in the setting of NA, plication should be delayed for 2 to 3 years to assess the possibility of spontaneous return of phrenic function.69 Overall, NA is an excellent model for understanding the physiology of primary disorders of the phrenic nerve, because hypoventilation has a unique presentation and therapeutic approach (Fig. 7).
Surgical treatment of diaphragmatic eventrations and paralyses
2010, Revue des Maladies RespiratoiresDiaphragm Disorders: Paralysis, Hernia, Eventration
2010, Medical Management of the Thoracic Surgery PatientDiaphragmatic Eventration
2009, Thoracic Surgery ClinicsCitation Excerpt :Another technique includes resecting the redundant portion of diaphragm and repairing the tissue in overlapping layers.7,15 Open transthoracic plication has also been described as an approach to treating bilateral diaphragm paralysis.50 Multiple single-institution studies have demonstrated significant improvement in symptoms and respiratory function after open transthoracic plication.42–46,51,52