Does your cousin have a diagnosis of having a paralyzed diaphragm as a result of the nerve being cut or symptoms indicating he does, such as shortness of breath after exertion, breathing problems, lack of stamina, etc. If so, he should see a thoracic surgeon, who can order the needed diagnostic tests, advise him, and perform plication surgery if he is a candidate. Paralyzed diaphragms are pretty rare, and plication surgery is not for the faint of heart. I'm putting it off for as long as I can but will do it when my symptoms are really limiting me. Many who have had it done are experiencing pain weeks and months afterwards and are taking months to recuperate, depending on how the surgeon does the procedure, how physically fit they are at the time of the surgery, etc. My surgeon didn't warn me about those things, which is why I'm grateful to the people on Mayo Connect and the people in the facebook paralyzed diagram group who have shared their actual experiences -- good and bad. I now know what to realistically expect and will be mentally prepared to deal with whatever comes. I hope your cousin is doing well. 3 heart surgeries is a lot to endure. His cardiologist can refer him to a thoracic surgeon, who would most likely know more about paralyzed diaphragms and treatment options than a pulmonologist.