Congenital Diaphragmatic Hernia Repair

Congenital diaphragmatic hernia is an embryologic defect in diaphragm formation that allows abdominal contents to enter into the fetal pleural cavity, resulting in ipsilateral lung compression, pulmonary hypoplasia, and abnormal pulmonary vasculature. Though diagnosis is frequently made on prenatal imaging, the diagnosis should be considered in any newborn with respiratory distress. Prenatal predictors of defect severity include evaluation of observed-to-expected lung volumes on fetal magnetic resonance imaging and lung-to-head ratio on fetal ultrasound. Treatment focuses on medical stabilization, including optimization of oxygenation and ventilation, followed by surgical repair. Anesthetic considerations for these patients include management of coexisting cardiac disease and ventilatory parameters, in addition to standard neonatal anesthetic considerations.

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Possibility of application of prenatal ultrasound indexes in congenital diaphragmatic hernia in fetus to determine postnatal outcomes

10.21516/2413-1458-2021-20-1-17-24 ◽

2021 ◽

Author(s):

N.V. Mashinets

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Pleural Cavity ◽

Prenatal Ultrasound ◽

Lung Hypoplasia ◽

Prenatal Period ◽

Compression Index ◽

Disease Group ◽

Group I ◽

Group Ii

Objectives. To assess the effectiveness of the use of prenatal ultrasound indexes in congenital diaphragmatic hernia of the fetus to determine the postnatal prognosis. Materials. The analysis of 95 observations of left-sided congenital diaphragmatic hernia of the fetus was carried out. In the prenatal period, the composition of organs displaced into the pleural cavity was determined, the heart compression index (HCI), O/E LHR according to Jani and DeKoninck, and QLI were calculated. Results. Survival rate of newborns was 57.9%, mortality rate was 42.1%. The newborns were divided into two groups depending on the outcome of the disease. Group I — surviving newborns (n = 55), group II — deceased patients (n = 40). In the analyzed groups, there were no statistical differences in the timing of delivery, birth weight of newborns, the severity of asphyxia after birth and the type of hernia. In group I, the intestinal loops and stomach were significantly more often identified in the pleural cavity in isolation, less often the liver. HCI corresponded to 1.3, Jani O/E LHR 45.7%, DeKoninck O/E LHR 38.7%, QLI 0.7. In group II, concomitant malformations, polyhydramnios and displacement of the liver into the pleural cavity were significantly more frequent. HCI was 1.5, Jani O/E LHR 38.6%, DeKoninck O/E LHR 32.0%, QLI 0.6. Conclusions. In predicting the outcome of the disease for a newborn, the most effective is a comprehensive assessment of the location of the liver, the heart compression index and the index of lung hypoplasia (O/E LHR according to Jani). The diagnostic accuracy of the method is 80%, the sensitivity is 74.4%, and the specificity is 83.3%.

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Hybrid Stage I Procedure as Initial Palliation for Neonate With Hypoplastic Left Heart Syndrome and Right Congenital Diaphragmatic Hernia

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253216687856 ◽

2017 ◽

Vol 21 (2) ◽

pp. 145-151 ◽

Cited By ~ 1

Author(s):

Draginja Cvetkovic ◽

Joseph Giamelli ◽

Michael Lyew ◽

Markus Erb ◽

Suvro Sett ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Hypoplastic Left Heart Syndrome ◽

Diaphragmatic Hernia ◽

Stage I ◽

Pulmonary Vasculature ◽

Coronary Perfusion ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Bilateral Pulmonary Artery Banding ◽

Left Heart Syndrome

During the past decade, a hybrid procedure has emerged and dramatically evolved as an alternative stage I palliation to the conventional Norwood procedure in neonates with hypoplastic left heart syndrome (HLHS). The hybrid approach avoids the need for cardiopulmonary bypass (CPB) utilizing stenting of the arterial duct and bilateral pulmonary artery banding. Cerebral and coronary perfusion pressure is maintained, and the pulmonary vasculature is protected from higher systemic pressure. Elimination of risks associated with CPB gains vital time to stabilize the patient and correct coexisting noncardiac anomalies and allows growth in preparation for the later stages of the Fontan pathway. The association of HLHS with right congenital diaphragmatic hernia (CDH) is rare. We report performing a successful hybrid stage I palliation on a neonate with HLHS and severe right CDH.

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