Long-term results of diaphragmatic plication in adults with unilateral diaphragm paralysis

Abstract

Background: In this study we aimed to evaluate the long-term outcome of diaphragmatic plication for symptomatic unilateral diaphragm paralysis.

Methods: Thirteen patients who underwent unilateral diaphragmatic plication (2 patients had right, 11 left plication) between January 2003 and December 2006 were evaluated. One patient died postoperatively due to sepsis. The remaining 12 patients [9 males, 3 females; mean age 60 (36-66) years] were reevaluated with chest radiography, flouroscopy or ultrasonography, pulmonary function tests, computed tomography (CT) or magnetic resonance imaging (MRI), and the MRC/ATS dyspnea score at an average of 5.4 (4-7) years after diaphragmatic plication.

Results: The etiology of paralysis was trauma (9 patients), cardiac by pass surgery (3 patients), and idiopathic (1 patient). The principle symptom was progressive dyspnea with a mean duration of 32.9 (22-60) months before surgery. All patients had an elevated hemidiaphragm and paradoxical movement radiologically prior to surgery. There were partial atelectasis and reccurent infection of the lower lobe in the affected side on CT in 9 patients. Atelectasis was completely improved in 9 patients after plication. Preoperative spirometry showed a clear restrictive pattern. Mean preoperative FVC was 56.7 ± 11.6% and FEV1 65.3 ± 8.7%. FVC and FEV1 improved by 43.6 ± 30.6% (p < 0.001) and 27.3 ± 10.9% (p < 0.001) at late follow-up. MRC/ATS dyspnea scores improved 3 points in 11 patients and 1 point in 1 patient at long-term (p < 0.0001). Eight patients had returned to work at 3 months after surgery.

Conclusions: Diaphragmatic plication for unilateral diaphragm paralysis decreases lung compression, ensures remission of symptoms, and improves quality of life in long-term period.

Figure 1

Preoperative chest X-ray of a 45-year-old female patient with diabetes who had dyspnea for 22 months shows that left diaphragm ascended up to infrahiler level.

Figure 2

Spiral CT of the patient in Fig. 1 shows the atelectasis in left lower lobe, and relocation and retraction of mesenteric adipose tissue and colon loops towards diaphragm.

Figure 3

Chest X-ray of the patient in Fig. 1 at the end of postoperative 3rd year shows that left diaphragm is in normal position and lung is fully expanded.

Figure 4

Three-dimensional multislice reconstruction of the patient in Fig. 1 at the end of postoperative 3rd year. Plicated left diaphragm is entirely in normal position.