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
Setting: A university hospital in The
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.
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