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Long-term Effect of Bilateral Plication of the Diaphragm^*

^* From the Departments of Pulmonology (Dr. Stolk) and Thoracic Surgery (Dr. Versteegh), Leiden University Medical Center, Leiden, The Netherlands.

Correspondence to: J. Stolk, MD, PhD, Department of Pulmonology (C3-P), Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands; e-mail: jstolk{at}pulmonology.azl.nl

Study objectives: To assess the feasibility and clinical outcome of bilateral plication of the diaphragm in patients with bilateral diaphragmatic paralysis (BDP) caused by neuralgic amyotrophy (NA), a mononeuritis of the phrenic nerves.

Design: Prospective, case-control study over a 1-year period.

Setting: A university hospital in The Netherlands.

Patients: Six patients who presented with BDP caused by NA.

Methods: The diagnosis of BDP was based on the absence of muscle response after cervical magnetic stimulation of both phrenic nerves. Three patients did not undergo surgery but were observed for a period of 2 years, and the other three patients underwent a limited lateral thoracotomy at the eighth intercostal space. Plication was performed by U-stitches until the diaphragm was as tight as possible. Vital capacity (VC) and arterial blood gas was measured during follow-up.

Results: One month postoperatively, mean VC measured in the supine position was significantly improved by 17%, and this effect was sustained for 12 months. Arterial PO₂ increased by 45%. VC and blood gas levels did not improve in the three patients that were only observed during the 2-year period. All three surgical patients could sleep in the supine position after the operation.

Conclusion: Bilateral plication of the diaphragm for NA-induced paralysis results in improvement of ventilation and blood gas exchange, allowing patients to sleep in the supine position without dyspnea.

Key Words: diaphragm • neurogenic amyotrophy paralysis • plication

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