| Abstract
| - Unilateral diaphragmatic paralysis and eventration have the sameappearance and provoke the same disturbances. Diaphragmatic plication isintended to decrease lung compression, to make the thoracic base andmediastinum more stable, and to strengthen the respiratory action ofintercostal, perithoracic, and abdominal muscles: 13 infants and childrenwere operated upon, 7 in acute respiratory failure andventilator-dependent, 4 in chronic respiratory failure; 11 adults wereoperated upon, 8 with respiratory and 3 with digestive symptoms. Fourinfants who had been operated upon before the 10th day of life died: 3 fromassociated diseases and 1 from a lung infection. The 9 survivors have beenfollowed up for a mean period of 6.6 years. All were asymptomatic and theposition of the plicated diaphragm was maintained. The 11 adults have beenfollowed up for a mean period of 8.5 years. Nine were asymptomatic; in 1,dyspnea had decreased; in 1, reflux persisted and was surgically cured. In5 adults, the respiratory tests showed a mean amelioration of 20% of vitalcapacity and 15% of forced expiratory volume in 1 s. In infants, theprognosis depends on associated malformations and on the condition of thelung. Plication should be performed after 2 weeks on a ventilator. In olderchildren and adults, plication is justified when the anomaly producessymptoms (malignancy excluded). Plication is simple, efficient, anddurable, but there is no indication of subsequent diaphragmatic function:its effects on respiratory mechanics are probably indirect.
|
