TY - JOUR
T1 - Effects of diaphragm plication on pulmonary function and cardiopulmonary exercise parameters
AU - Welvaart, Willem N.
AU - Jak, Patrick M. C.
AU - van de Veerdonk, Marielle C.
AU - Marcus, Johannes T.
AU - Ottenheijm, Coen A. C.
AU - Paul, Marinus A.
AU - Vonk Noordegraaf, Anton
PY - 2013/10
Y1 - 2013/10
N2 - Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.
AB - Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.
KW - Cardiopulmonary exercise tests
KW - Diaphragm
KW - Dyspnoea
KW - Paralysis
UR - http://www.scopus.com/inward/record.url?scp=84896951024&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/ejcts/ezt094
DO - https://doi.org/10.1093/ejcts/ezt094
M3 - Article
C2 - 23449864
SN - 1010-7940
VL - 44
SP - 643
EP - 647
JO - European journal of cardio-thoracic surgery
JF - European journal of cardio-thoracic surgery
IS - 4
M1 - ezt094
ER -