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The Diaphragm: Introduction and Basics

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Minimally Invasive Thoracic and Cardiac Surgery

Abstract

The diaphragm (Greek: dia = between; phragma = fence) is a musculoaponeurotic structure that separates the thoracic and abdominal cavities [1]. It is, however, not just “the thoracic floor” but the most important muscle of respiration [2] and also plays an important role in preventing gastroesophageal reflux. Impairment of diaphragmatic function can have major physiological consequences. Many of these impairments are amenable for surgical correction, but correct diagnosis and treatment require thorough understanding of form and function. The old maxim: “Let them never forget that without anatomy there is no physiology, no surgery, no medicine” holds true also for the diaphragm [3].

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References

  1. Anraku M, Shargall Y (2009) Surgical conditions of the diaphragm; anatomy and physiology. Thorac Surg Clin 19:419–429

    Article  PubMed  Google Scholar 

  2. Epstain S (1994) An overview of respiratory muscle function. Clin Chest Med 15:619–639

    Google Scholar 

  3. Cruveilhier J (1834) Traite d’Anantomie descriptive. Asselin, Paris, 1827

    Google Scholar 

  4. McVay CB (1984) Thoracic walls: the diaphragm. In: Anson & McVay: surgical anatomy, vol I, 6th edn. WB Saunders, Philadelphia, pp 365–384

    Google Scholar 

  5. Loeweneck H, Feifel G (2003) Zwerchfell. In: Lanz & Wachsmuth: praktische anatomie, 2nd edn. Springer, Berlin, pp 89–103

    Google Scholar 

  6. Matthew LH (1958) The biology of whales. New Sci 4(107):1426–1427

    Google Scholar 

  7. Souilamas R, Hidden G, Riquet M (2001) Mediastinal lymphatic efferents from the diaphragm. Surg Radiol Anat 23(3):159–162

    Article  PubMed  CAS  Google Scholar 

  8. Merendino KA, Johnson RS, Skinner HH et al (1956) The intradiaphragmatic distribution of the phrenic nerve with particular reference to the placement of diaphragmatic incisions and controlled segmental paralysis. Surgery 39:189–198

    PubMed  CAS  Google Scholar 

  9. Kirschner PA (1998) Porous diaphragm syndromes. Chest Surg Clin N Am 8(2):449–472

    PubMed  CAS  Google Scholar 

  10. De Troyer A, Estenne M (1988) Functional anatomy of the respiratory muscles. Clin Chest Med 9(2):175–193

    PubMed  Google Scholar 

  11. Geiger PC, Cody MJ, Macken RL et al (2000) Maximum specific force depends on myosin heavy chain content in rat diaphragm muscle fibers. J Appl Phys 89(2):695–703

    CAS  Google Scholar 

  12. Pourriat JL, Lamberto C, Hoang PH et al (1986) Diaphragmatic fatigue and breathing pattern during weaning from mechanical ventilation in COPD patients. Chest 90(5):703–707

    Article  PubMed  CAS  Google Scholar 

  13. Welvaart WN, Paul MA, Stienen GJ, van Hees HW, Loer SA, Bouwman R, Niessen H, de Man FS, Witt CC, Granzier H, Vonk-Noordegraaf A, Ottenheijm CA. Ann Surg. 2011 Dec;254(6):1044-9.

    Google Scholar 

  14. Pickering M, Jones JF (2002) The diaphragm: two physiological muscles in one. J Anat 201(4):205–212

    Article  Google Scholar 

  15. Hoover CF (1913) The functions of the diaphragm and their diagnostic significance. Arch Intern Med 12:214–224

    Article  Google Scholar 

  16. Pacia EB, Aldrich TK (1998) Assessment of diaphragm function. Chest Surg Clin N Am 8(2):225–236

    PubMed  CAS  Google Scholar 

  17. Roberts HC (2009) Imaging the diaphragm. Thorac Surg Clin 19(4):431–451

    Article  PubMed  Google Scholar 

  18. Tarver RD, Conces DJ, Cory DA et al (1989) Imaging the diaphragm and its disorders. J Thorac Imaging 4:1–18

    Article  PubMed  CAS  Google Scholar 

  19. Levine S, Nguyen T, Taylor N et al (2008) Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 358(13):1327–1335

    Article  PubMed  CAS  Google Scholar 

  20. Brander L, Leong-Poi H, Beck J et al (2009) Titration and implementation of neurally adjusted ventilatory assist in critically ill patients. Chest 135(3):695–703

    Article  PubMed  Google Scholar 

  21. Onders RP, Elmo M, Khansarinia S et al (2009) Complete worldwide operative experience in laparoscopic diaphragm pacing: results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients. Surg Endosc 23(7):1433–1440

    Article  PubMed  Google Scholar 

  22. Welvaart WN, Becker A, Marcus JT et al (2010) Unusual treatment of patent foramen ovale after pneumonectomy. Eur Resp J 35(4):929–931

    Article  CAS  Google Scholar 

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Correspondence to Willem Nicolaas Welvaart M.D. .

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Welvaart, W.N., Paul, M.A. (2012). The Diaphragm: Introduction and Basics. In: Inderbitzi, R., Schmid, R., Melfi, F., Casula, R. (eds) Minimally Invasive Thoracic and Cardiac Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11861-6_35

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  • DOI: https://doi.org/10.1007/978-3-642-11861-6_35

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  • Online ISBN: 978-3-642-11861-6

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