Effects of diaphragm plication on pulmonary function and cardiopulmonary exercise parameters

Paralysis of the diaphragm is an uncommon condition, which may result in dyspnoea on excertion and in orthopnea. In patients who have symptoms, the paralysed diaphragm is often plicated to prevent its paradoxical movement on inspiration. This procedure brings relief to many patients, but the mechani...

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Bibliographic Details
Published in:European journal of cardio-thoracic surgery 2013-10, Vol.44 (4), p.643-647
Main Authors: Welvaart, Willem N, Jak, Patrick M C, van de Veerdonk, Mariëlle C, Marcus, Johannes T, Ottenheijm, Coen A C, Paul, Marinus A, Vonk Noordegraaf, Anton
Format: Article
Language:English
Subjects:
Adult
Aged
Analysis of Variance
Diaphragm - physiopathology
Diaphragm - surgery
Dyspnea - physiopathology
Exercise - physiology
Exercise Test - methods
Female
Humans
Male
Middle Aged
Prospective Studies
Respiratory Function Tests
Respiratory Paralysis - physiopathology
Respiratory Paralysis - surgery
Respiratory Physiological Phenomena
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Summary:Paralysis of the diaphragm is an uncommon condition, which may result in dyspnoea on excertion and in orthopnea. In patients who have symptoms, the paralysed diaphragm is often plicated to prevent its paradoxical movement on inspiration. This procedure brings relief to many patients, but the mechanism for this improvement is not well understood. Nine symptomatic patients who underwent plication of a unilateral paralysed hemidiaphragm were prospectively evaluated. All patients underwent pulmonary function tests and cardiopulmonary exercise tests before surgery and repeated them after surgery. Patients with hemidiaphragm paralysis before surgery were found to have lower tidal volumes at any given ventilation rate during exercise than normal subjects. A clear and consistent change was found in the manner in which patients increased their ventilation during exercise after surgery. All patients showed an increase in tidal volume for a given ventilation rate, which was significant. The plication procedure reduced the respiratory rate for any exercise level in all patients, and this effect was more pronounced during exercise. In patients with hemidiaphragm paralysis who underwent a diaphragm plication exercise, tidal volumes increased and the ventilatory frequency decreased. Despite this improvement, maximal exercise capacity remained unaltered.
ISSN:1010-7940
1873-734X
DOI:10.1093/ejcts/ezt094