Abstract
Background: Congenital diaphragmatic hernia (CDH) is associated with significant neonatal morbidity and mortality. Although prenatal complete tracheal occlusion (cTO) causes hypoplastic CDH lungs to enlarge, improved lung function has not been demonstrated. Furthermore, cTO interferes with the dynamic pressure change and fluid flow associated with fetal breathing. Purpose: The purpose of the study was to assess a novel dynamic tracheal occlusion (dTO) device that preserves pressure changes and fluid flow. Methods: In this pilot study, CDH was created in fetal lambs at 65 days of gestational age (GA). At 110 days GA, a cTO device (n = 3) or a dTO device (n = 4) was placed in the fetal trachea. At 135 days GA, lambs were delivered and resuscitated. Unoperated lamb co-twins (n = 5), sham thoracotomy lambs (n = 2), and untreated CDH lambs (n = 3) served as controls. Results: Tracheal opening pressure, lung volume, lung fluid total protein, and phospholipid were significantly higher in the cTO group than in the dTO and unoperated control groups. Maximal oxygenation and lung compliance were significantly lower in the cTO group when compared with the unoperated control and dTO groups. Conclusion: Preliminary results suggest that in the fetal lamb CDH model, dTO restores normal lung morphometrics and function, whereas cTO leads to enlarged but less functional lungs.
Original language | English (US) |
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Pages (from-to) | 1150-1157 |
Number of pages | 8 |
Journal | Journal of pediatric surgery |
Volume | 46 |
Issue number | 6 |
DOIs | |
State | Published - Jun 2011 |
Funding
We would like to thank Hart Horneman for her technical assistance with lung fluid composition analysis. We would also like to thank Medtronic for generously donating the ventriculo-peritoneal shunt valves for use in this study. This work was supported by the National Institutes of Health K08 HL092062 (DM), F32 HL097400 (EBJ), and T32 GM008258 (SCS) as well as the UCSF Academic Senate Individual Investigator Grant (DM).
Keywords
- Congenital diaphragmatic hernia
- Lung
- Pulmonary hypertension
- Tracheal occlusion
ASJC Scopus subject areas
- Surgery
- Pediatrics, Perinatology, and Child Health