Function of the diaphragm before and after plication.

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Abstract
To determine the mechanism primarily responsible for increase in lung volume after plication, transdiaphragmatic pressure, pleural pressure, and abdominal pressure were measured in a patient (17 mo. old girl) with severe bilateral diaphragmatic weakness before and after bilateral diaphragm plication. The chest radiographs before and after surgery obtained at end-inspiration at the same positive airway pressure showed no change in the configuration of the chest wall after surgery. The diaphragms are in a more normal position after surgery. Lung volume appeared to have increased after plication. The increase in lung volume after plication did not result from the diaphragm acting as a more effective pressure:partition. It was caused primarily by changes in the geometric configuration of the diaphragm. A change in the geometrical configuration of the diaphragm and thorax may reduce microatelectasis, and thus increase pulmonary compliance.