| Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis. | |
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MedLine Citation:
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PMID: 19766791 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Patients with lifestyle-limiting dyspnea attributable to unilateral diaphragm paralysis have been shown to experience a decrease in their dyspnea and an improvement in their pulmonary spirometry and functional status with diaphragm plication acutely after surgery. This investigation summarizes these patients' outcomes with long-term follow-up. METHODS: Adult patients undergoing plication of the hemidiaphragm for lifestyle-limiting dyspnea secondary to unilateral diaphragm paralysis were assessed preoperatively, 6 month after surgery and then annually using the Medical Research Council dyspnea score, pulmonary spirometry, activities of daily living questionnaire, and a chest radiograph. Patients with at least 48 months of follow-up were included in this investigation. RESULTS: Forty-one patients underwent plication of the hemidiaphragm through video-assisted thoracoscopy (30) or thoracotomy (11). Mean follow-up was 57 +/- 10 months. Mean forced vital capacity, forced expiratory volume at 1 second, functional residual capacity, and total lung capacity all improved by 19%, 23%, 21%, and 19% (p < 0.005), respectively, when measured 6 months after surgery, as were mean Medical Research Council dyspnea scores (p < 0.0001). These mean values remained constant over the follow-up period. Four patients did not show improvement in their Medical Research Council dyspnea scores nor functional status despite improvements in their pulmonary spirometry values. Two of these patients had a body mass index greater than 35 kg/m(2) and 3 had documented unilateral diaphragm paralysis for at least 4 years before plication. CONCLUSIONS: Plication of the hemidiaphragm produces improvement for the vast majority of patients in pulmonary spirometry, dyspnea, and functional status that endures over long-term follow-up. Patients who are morbidly obese or who have longstanding unilateral diaphragm paralysis may not realize the same benefits of plication. |
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Authors:
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Richard K Freeman; Jaclyn Van Woerkom; Amy Vyverberg; Anthony J Ascioti |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 88 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-09-21 Completed Date: 2009-10-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1112-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana, USA. rfreeman@corvascmds.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Diaphragm / physiology* Female Follow-Up Studies Humans Male Middle Aged Recovery of Function / physiology* Respiratory Function Tests Respiratory Paralysis / physiopathology, surgery* Retrospective Studies Thoracic Surgical Procedures / methods* Time Factors Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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