scholarly journals Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Preterm Neonate at 1 Kilogram

2021 ◽  
Vol 09 (01) ◽  
pp. e13-e16
Author(s):  
Muhammad Choudhry ◽  
Simona Rusu ◽  
Peter Brooks ◽  
Enitan Ogundipe ◽  
Shu-Ling Chuang
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Neurodevelopmental Outcome ◽  
Postoperative Recovery ◽  
Arterial Blood Gas ◽  
Blood Gas Monitoring ◽  
Arterial Blood ◽  
Thoracoscopic Repair ◽  
One Year ◽  
End Tidal

AbstractWe report the first successful primary thoracoscopic repair of congenital diaphragmatic hernia (CDH) in a preterm infant born at 28 weeks of gestation weighing 1,043 g. Left-sided CDH was incidentally diagnosed on postnatal chest X-ray on day 1. The neonate subsequently underwent thoracoscopic repair with primary closure of the defect on day 8 weighing 1,150 g. Intraoperative arterial blood gas monitoring including end tidal carbon-dioxide remained within normal range throughout. Postoperative recovery was uneventful. One year neurodevelopmental outcome was normal for age with no CDH recurrence.

scholarly journals Light at the end of the tunnel: a technical note on thoracoscopic repair of congenital diaphragmatic hernia

2011 ◽  
Vol 1 (1) ◽  
pp. 6
Author(s):  
Claire R. Jackson ◽  
Gordan A. MacKinlay ◽  
Merrill McHoney
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Postoperative Recovery ◽  
Technical Note ◽  
Diaphragmatic Defect ◽  
Hernia Sac ◽  
Thoracoscopic Repair ◽  
Technical Learning ◽  
Number Of Authors

Thoracoscopic repair of congenital diaphra­gmatic hernia (CDH) has been described by a number of authors and is increasingly widely practiced. We present a technical learning point. CDH is associated with the presence of a hernia sac in around 20% of all cases. In this case the presence of a ruptured hernia sac complicated the thoracoscopic repair of a left sided CDH, as it was initially difficult to recognise. Once the anatomy was clarified the repair was satisfactorily completed and the child made a rapid postoperative recovery. This technical note is to warn other surgeons that a tunnel like appearance of the diaphragmatic defect may in fact be due to the presence of a torn hernia sac, which requires excision before closure of the defect.

scholarly journals Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Neonates: Lessons Learned

2009 ◽  
Vol 19 (4) ◽  
pp. 575-580 ◽  
Author(s):  
Anne C. Kim ◽  
Benjamin S. Bryner ◽  
Begum Akay ◽  
James D. Geiger ◽  
Ronald B. Hirschl ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Lessons Learned ◽  
Thoracoscopic Repair

scholarly journals Malignant Hyperthermia during Thoracoscopic Pulmorrhaphy in a 70-Year-Old Man

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Michihiro Sakai ◽  
Noriko Murakami ◽  
Yuji Kitamura ◽  
Shin Sato ◽  
Hiroshi Iwama ◽  
...  
Keyword(s):  
Malignant Hyperthermia ◽  
Lung Ventilation ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
History Of ◽  
End Tidal ◽  
High Degree

Malignant hyperthermia (MH) is a rare but potentially fatal complication that may develop under general anesthesia (GA) and is rarely reported in elderly patients. We encountered a case of mild-onset MH in a 70-year-old patient who was receiving an elective thoracoscopic pulmorrhaphy and had a history of several GA procedures. Anesthesia was induced with propofol, fentanyl, and rocuronium and maintained with sevoflurane and remifentanil. His body temperature (BT) was 37.9°C after induction. During the procedure, the end-tidal CO2(ETCO2) increased steadily to 47–50 mmHg, presumably in response to the single lung ventilation. At the end, BT was 38.1°C and ETCO2was 47 mmHg under spontaneous breathing. After extubation, the patient wheezed on inspiration and expiration, and his trachea was reintubated. Sixty minutes after surgery, BT increased to 40.5°C and the arterial blood gas analysis showed severe metabolic acidosis. Based on these findings, MH was suspected and a bolus dose of dantrolene was administered. He responded to the dantrolene, and no complications or recurrence of MH was observed postoperatively. In this patient, the initial signs of MH were so subtle that making the diagnosis of MH was difficult. A high degree of suspicion is necessary to prevent a fulminant MH crisis.

Effects of tracheal occlusion on the neonatal cardiopulmonary transition in an ovine model of diaphragmatic hernia

2019 ◽  
Vol 104 (6) ◽  
pp. F609-F616 ◽  
Author(s):  
Philip L J DeKoninck ◽  
Kelly J Crossley ◽  
Aidan J Kashyap ◽  
Sasha M Skinner ◽  
Marta Thio ◽  
...  
Keyword(s):  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Diaphragmatic Hernia ◽  
Weight Ratio ◽  
Lung Compliance ◽  
Ovine Model ◽  
Lung Weight ◽  
Tracheal Occlusion ◽  
Arterial Blood Gas ◽  
Arterial Blood

ObjectiveFetoscopic endoluminal tracheal occlusion (FETO) aims to reverse pulmonary hypoplasia associated with congenital diaphragmatic hernia (CDH) and mitigate the associated respiratory insufficiency and pulmonary hypertension after birth. We aimed to determine whether FETO improves the cardiopulmonary transition at birth in an ovine model of CDH.MethodsIn 12 ovine fetuses with surgically induced diaphragmatic hernia (DH; 80 dGA), an endotracheal balloon was placed tracheoscopically at ≈110 dGA and removed at ≈131 dGA (DH+FETO), while 10 were left untreated (DH). At ≈138 dGA, all lambs (survival at delivery: 67% [DH+FETO], 70% [DH]) were delivered via caesarean section and ventilated for 2 hours. Physiological and ventilation parameters were continuously recorded, and arterial blood-gas values were measured.ResultsCompared with DH, DH+FETO lambs had increased wet lung-to-body-weight ratio (0.031±0.004 vs 0.016±0.002) and dynamic lung compliance (0.7±0.1 vs 0.4±0.1 mL/cmH2O). Pulmonary vascular resistance was lower in DH+FETO lambs (0.44±0.11 vs 1.06±0.17 mm Hg/[mL/min]). However, after correction for lung weight, pulmonary blood flow was not significantly different between the groups (4.19±0.57 vs 4.05±0.60 mL/min/g). Alveolar–arterial difference in oxygen tension was not significantly different between DH+FETO and DH (402±41mm Hg vs 401±45 mm Hg).ConclusionsFETO accelerated lung growth in fetuses with CDH and improved neonatal respiratory function during the cardiopulmonary transition at birth. However, despite improved lung compliance and reduced pulmonary vascular resistance, there were less pronounced benefits for gas exchange during the first 2 hours of life.

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