Plication of paralyzed hemidiaphragm after right sleeve pneumonectomy

Right diaphragmatic plication was performed in a 62-year-old man who underwent right sleeve pneumonectomy and then required prolonged mechanical ventilation owing to right diaphragmatic paralysis. The plication was very effective in allowing him to be weaned from the ventilator. The transdiaphragmatic pressure, the ratio of gastric to esophageal pressure swing, and the work of breathing per liter of ventilation improved remarkably after plication. Our experience indicates the beneficial effect of such a plication on contralateral lung function from the standpoint of clinical and respiratory mechanics.