We report the use of video-assisted thoracic surgery to plicate the di
aphragm after phrenic nerve injury associated with an operation for co
ngenital heart disease. Right diaphragm paresis developed in a cyanoti
c newborn girl with pulmonary atresia and intact ventricular septum af
ter a right modified Blalock-Taussig shunt. Diaphragm plication was pe
rformed endoscopically and the patient recovered. Refinement of techni
que and instrumentation may allow wider application of video-assisted
thoracoscopic plication of the diaphragm in neonatal and pediatric pat
ients. (C) 1998 by The Society of Thoracic Surgeons.