Chest wall mechanics before and after diaphragm plication
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CASE REPORT
Open Access
Chest wall mechanics before and after diaphragm plication Ghazi Elshafie1,4, Johanna Acosta2, Andrea Aliverti3, Amy Bradley1, Prem Kumar4, Pala Rajesh1 and Babu Naidu1,4*
Abstract Background: Following diaphragmatic plication for unilateral paralysis, the effect on global chest wall function are unknown. Our hypothesis was that chest wall function would improve in both sides of the chest after plication of the paralysed side. Case Presentation: Using Optoelectronic Plethysmography, total and regional chest wall volumes were measured in one patient before and after left diaphragmatic plication. Volumes were recorded at quiet breathing. Respiratory capacity improved during quiet breathing when measured before and 6 months after surgery. These improvements occur at the abdominal-rib cage level in both operated and contralateral. Prior to surgery the abdominal rib cage motion was out of phase to the upper rib cage and abdominal compartment in both sides of the chest. Synchrony of all three compartments was restored after plication. Conclusion: This physiological study is the first published data in humans to show improvement in chest wall motion both in operated and contralateral side following diaphragmatic plication for unilateral paralysis. Keywords: Chest wall motion, Diaphragmatic paralysis, Plication, Optoelectronic Plethysmography
Background Diaphragmatic paralysis has a significant symptom burden on patients’ quality of life. This is largely because of its paradoxical movement during respiration [1]. We know that by plicating (double breasting and making taut) the floppy paralysed diaphragm there is improvement in pulmonary function and patients symptoms of breathlessness [2, 3]. However little is known about how this improvement alters dynamic chest wall function. We hypothesize that due to the paradoxical movement of unilateral paralysed diaphragm, abdominal (lower) rib cage chest wall motion on both sides of the chest is impaired and that plication reverses this impairment by preventing that paradoxical movement. Case presentation A prospective observational study was undertaken in a regional thoracic centre in a Local Research Ethics Committee approved study. Informed consent was obtained * Correspondence: [email protected] 1 Heart of England Foundation Trust, Birmingham B9 5SS, UK 4 Birmingham Medical School, University of Birmingham, Birmingham, UK Full list of author information is available at the end of the article
from the participant. This study was carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. Using Optoelectronic Plethysmography (OEP) [4, 5], total and regional chest wall volumes were measured in a male patient with left sided idiopathic diaphragmatic paralysis (Fig. 1). He was diagnosed with ‘asthma’ and had a long history postural shortness of breath and recurrent respiratory tract infections. He was scheduled for diaphragmatic plication. Surgery was performed under gener
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