Background: Diaphragm plication is an effective and safe procedure for patients with symptomatic, acquired diaphragm paralysis. Improvements in dyspnea scores, ventilation perfusions and exercise capacity has been reported. Unfortunately, no continuous measurements of lung functions at 3 to 5 years' follow-up have been recorded. This study was designed to assess the long-term effects and potential mechanism of diaphragm plication for non-malignant diaphragmatic paralysis patients, especially in relation to patients' subjective and objective improvement.
Methods: This study retrospectively reviewed the medical records of 36 adult patients with diaphragmatic paralysis treated with diaphragm plication by thoracotomy at the Tianjin Chest Hospital from 1992 to 2016. The adult patients were carefully selected based on etiology and a combination of clinical manifestation, pulmonary function testing, and chest imaging characteristics. Patients' preoperative pulmonary functions, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in the supine and sitting positions were recorded. Survival information was obtained at follow-ups continuously conducted with 8 patients for 4 years after surgery.
Results: The main symptoms were lifestyle-limiting dyspnea and orthopnea, and a few patients also had digestive symptoms. The mean body mass index of patients was 26.02±2.19. The etiology was trauma in 3 patients, and surgery in 5 patients. The operated diaphragm was found to be lower than the contralateral diaphragm in the first 3 months after surgery; however, from the 4th month, both sides of the diaphragm were basically at the same level. Additionally, 31 patients (86.11%) showed an improvement in subjective symptoms, especially digestive symptoms preoperatively. The averages of FVC and FEV1 increased by 26.8% and 24.3%, respectively, in patients 6 months after diaphragmatic plication, and from the 18th month, lung function declined gradually, returning to preoperative levels in the 4th year.
Conclusions: Diaphragmatic plication can obviously improve the lung function and subjective symptoms of patients in the short term, but from the 18th month, lung function declined gradually to preoperative levels in the 4th year indicated that its long-term effect on lung function is poor. The major purpose of diaphragmatic plication is to balance the position of the heart and abdominal organs, and thus to improve patients' symptoms to a certain extent.
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http://dx.doi.org/10.21037/jtd-22-983 | DOI Listing |
Diagnostics (Basel)
December 2024
Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy.
Dynamic digital radiography (DDR) is a recent imaging technique that allows for real-time visualization of thoracic and pulmonary movement in synchronization with the breathing cycle, providing useful clinical information. A 46-year-old male, a former smoker, was evaluated for unexplained dyspnea and reduced exercise tolerance. His medical history included a SARS-CoV-2 infection in 2021.
View Article and Find Full Text PDFKyobu Geka
October 2024
Department of Cardiovascular Surgery, Saga-ken Medical Centre Koseikan, Saga, Japan.
When respiratory failure occurs due to intractable pleural effusion, frequent thoracentesis is necessary. We herein report a patient who underwent diaphragmoplasty and pleuroperitoneal shunt for refractory pleural effusion after cardiac surgery. The patient was an 82-year-old man with a history of tricuspid valve replacement for tricuspid regurgitation 9-years ago.
View Article and Find Full Text PDFCureus
October 2024
Department of Surgery, Zen Hospital, Mumbai, IND.
Diaphragmatic eventration (DE) is characterized by abnormal diaphragm elevation resulting from muscle weakness or thinning. It may be congenital or acquired, affecting both pediatric and adult populations, and is associated with symptoms such as dyspnea and chest pain. Although DE is infrequent, with a higher incidence on the left side, it has traditionally been managed through invasive surgical techniques.
View Article and Find Full Text PDFJ Med Case Rep
October 2024
Dept. of General Surgery, Anadolu Medical Center, Kocaeli, Turkey.
Background: Chilaiditi's sign is an incidental radiographic finding, associated with intestinal disposition located between liver and right diaphragm. It is considered as an acquired rather than a congenital condition and the prevalence ranges from 1.18% to 2.
View Article and Find Full Text PDFJ Pediatr Surg
January 2025
Pediatric Surgery Unit, Federation of Pediatrics, University Hospital Centre, Angers, France. Electronic address:
Background: The aims of this study were to describe the characteristics of children with congenital diaphragmatic eventration (CDE) and compare the outcomes of surgical and conservative treatment of pediatric CDE in France.
Methods: Retrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age diagnosed with CDE between 2010 and 2021. Patients with surgical or conservative treatment were compared.
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