TY - JOUR
T1 - Dynamic tracheal occlusion improves lung morphometrics and function in the fetal lamb model of congenital diaphragmatic hernia
AU - Jelin, Eric B.
AU - Etemadi, Mozziyar
AU - Encinas, Jose
AU - Schecter, Samuel C.
AU - Chapin, Cheryl
AU - Wu, Jianfeng
AU - Guevara-Gallardo, Salvador
AU - Nijagal, Amar
AU - Gonzales, Kelly D.
AU - Ferrier, William T.
AU - Roy, Shuvo
AU - Miniati, Doug
N1 - Funding Information:
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).
PY - 2011/6
Y1 - 2011/6
N2 - 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.
AB - 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.
KW - Congenital diaphragmatic hernia
KW - Lung
KW - Pulmonary hypertension
KW - Tracheal occlusion
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U2 - 10.1016/j.jpedsurg.2011.03.049
DO - 10.1016/j.jpedsurg.2011.03.049
M3 - Article
C2 - 21683214
AN - SCOPUS:79959304217
SN - 0022-3468
VL - 46
SP - 1150
EP - 1157
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 6
ER -