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Respiratory Disorders (Expert Forum)
plication
Answered by
CO
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plication
by jcason, Nov 25, 2008 12:28PM
I had mitral valve replacement 12/06/05 and have been on oxygen ever since. They say the right diaphragm is paralyzed. I am 72 years old woman and had a difficult time with the anesthesia and had a 13 day recovery time in the hospital. I was diagnosed with PTS after surgery that may have been caused by the anesthsia. Lots of hallluciinations for a time and the Dr. didn't know if I wanted to go back for more surgery after those results. Those symptioms went away after about a the 1st week. I've had several tests but my breathing far nothing has improved and it seems to be getting more difficult to breath and I am currently on 3.5 liter of ozygen. I weigh 215lbs. 5'6" tall and cannot exercise. Would weight loss help?. I was down to 190 in 2007 but that didn't make any difference. Is it useless to consider any surgery for a questionable outcome? Would the Plication make my life more tolerable? I can't walk very far due to my instability and tendancy to "wander" without holding onto something or someone. It is difficult to travel so it is definitly ruining our retirement activity. What should I do?
Doctor's Answer
by National Jewish Health, Dec 03, 2008 05:10PM
, Dec 03, 2008 05:10PM
A low arterial blood oxygen level due to paralysis of a hemi-diaphragm is unusual, but not rare, in the absence of underlying lung disease. However, the ill-effects of such paralysis is accentuated by your being overweight. Nevertheless, that may not be enough to explain your need for relatively high flow oxygen of 3.5 liters per minute. Were that the cause, however, the surgical procedure you mention, plication of the diaphragm, might result in improved blood oxygen levels, less need for the use of oxygen and a reduction in shortness of breath.
The mitral valve replacement, itself should not have resulted in your need for oxygen unless it resulted in an alteration of blood flow within the upper chambers of your heart of a type that has also been associated with paralysis of the right hemi-diaphragm and that is called a patent foramen ovale (PFO). The following, from the medical literature, is an abstract that describes that circumstance. I know this may be hard to follow and understand but your doctors will understand it.
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Authors
Full Name Ghamande, S. Ramsey, R. Rhodes, J F. Stoller, J K.
Institution Department of Pulmonary and Critical Care Medicine, the Cleveland
Clinic Foundation, Cleveland, OH 44195, USA.
Title Right hemidiaphragmatic elevation with a right-to-left interatrial shunt
through a patent foramen ovale: a case report and literature review.
Source Chest. 120(6):2094-6, 2001 Dec.
Abstract A right-to-left shunt (RLS) is an uncommon complication of a patent foramen ovale (PFO) that may cause hypoxemia from venous admixture and ischemic complications from paradoxic embolization. This report presents the third described patient whose RLS through a PFO and profound hypoxemia developed in association with right hemidiaphragm dysfunction (but without a pressure gradient driving the right-to-left flow). In addition to extending the available experience with this unusual clinical event, we report on the successful closure of the PFO by a catheter-deployed double-umbrella device, after the positioning of which the patient's oxygenation normalized.
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The primary action to be taken at this time is to accurately identify the cause of your low oxygen levels and to seek consultation with a thoracic, commonly known as a chest, surgeon, familiar with and experienced with the surgical procedure of diaphragmatic placation. Unfortunately, your being overweight might preclude this surgery and even without the surgery, you should make an intensive effort to lose weight as that does have the potential to change your health and the quality of your life.
Good luck.
The mitral valve replacement, itself should not have resulted in your need for oxygen unless it resulted in an alteration of blood flow within the upper chambers of your heart of a type that has also been associated with paralysis of the right hemi-diaphragm and that is called a patent foramen ovale (PFO). The following, from the medical literature, is an abstract that describes that circumstance. I know this may be hard to follow and understand but your doctors will understand it.
-----------------------------------------------------------------------------------------------
Authors
Full Name Ghamande, S. Ramsey, R. Rhodes, J F. Stoller, J K.
Institution Department of Pulmonary and Critical Care Medicine, the Cleveland
Clinic Foundation, Cleveland, OH 44195, USA.
Title Right hemidiaphragmatic elevation with a right-to-left interatrial shunt
through a patent foramen ovale: a case report and literature review.
Source Chest. 120(6):2094-6, 2001 Dec.
Abstract A right-to-left shunt (RLS) is an uncommon complication of a patent foramen ovale (PFO) that may cause hypoxemia from venous admixture and ischemic complications from paradoxic embolization. This report presents the third described patient whose RLS through a PFO and profound hypoxemia developed in association with right hemidiaphragm dysfunction (but without a pressure gradient driving the right-to-left flow). In addition to extending the available experience with this unusual clinical event, we report on the successful closure of the PFO by a catheter-deployed double-umbrella device, after the positioning of which the patient's oxygenation normalized.
-----------------------------------------------------------------------------------------------
The primary action to be taken at this time is to accurately identify the cause of your low oxygen levels and to seek consultation with a thoracic, commonly known as a chest, surgeon, familiar with and experienced with the surgical procedure of diaphragmatic placation. Unfortunately, your being overweight might preclude this surgery and even without the surgery, you should make an intensive effort to lose weight as that does have the potential to change your health and the quality of your life.
Good luck.
If you can't do any other activity, I suggest lifting light weights with your arms while on high flow oxygen. Exercise With Oxygen Therapy can be very beneficial. Come by Heart Failure Solutions for more helpful ideas. The simple things you can do for yourself deserve some attention before you risk surgery again.
Many blessings.