PURPOSE: We reviewed 24 consecutive cases of prenatally or immediately postnatally diagnosed left-sided congenital diaphragmatic hernia (CDH) to evaluate pulmonary artery (PA) size as an indication for thoracoscopic repair (TR). METHODS: CDH repair is planned once echocardiography confirms improvement in pulmonary hypertension. TR is chosen if cardiopulmonary status is stable more than 10 min in the decubitus position in the neonatal intensive care unit (NICU) under conventional mechanical or high frequency oscillatory ventilation (HFOV) with/without nitric oxide (NO) and the patient appears likely to tolerate manual ventilation during transfer to the operating room. Otherwise open repair (OR) is performed in NICU. Proximal right PA (RPA) and left PA (LPA) diameters measured at birth were assessed with respect to the type of repair. RESULTS: 10/24 had TR and 14/24 had OR. TR cases had significantly larger RPA/LPA diameters (3.52 ± 0.23 vs. 3.10 ± 0.56 mm, p < 0.05 for RPA; 3.04 ± 0.26 vs. 2.48 ± 0.37, p < 0.01 for LPA), and significantly less requirement for HFOV (70 vs. 100 %, p < 0.05) and NO (20 vs. 86 %, p < 0.01). Four TR required conversion to OR for technical reasons (n = 3) and cardiopulmonary instability (n = 1). CONCLUSIONS: TR can be considered when RPA/LPA diameters are larger than 3.0/2.5 mm, respectively, and cardiopulmonary status is stable without NO.
PURPOSE: We reviewed 24 consecutive cases of prenatally or immediately postnatally diagnosed left-sided congenital diaphragmatic hernia (CDH) to evaluate pulmonary artery (PA) size as an indication for thoracoscopic repair (TR). METHODS: CDH repair is planned once echocardiography confirms improvement in pulmonary hypertension. TR is chosen if cardiopulmonary status is stable more than 10 min in the decubitus position in the neonatal intensive care unit (NICU) under conventional mechanical or high frequency oscillatory ventilation (HFOV) with/without nitric oxide (NO) and the patient appears likely to tolerate manual ventilation during transfer to the operating room. Otherwise open repair (OR) is performed in NICU. Proximal right PA (RPA) and left PA (LPA) diameters measured at birth were assessed with respect to the type of repair. RESULTS: 10/24 had TR and 14/24 had OR. TR cases had significantly larger RPA/LPA diameters (3.52 ± 0.23 vs. 3.10 ± 0.56 mm, p < 0.05 for RPA; 3.04 ± 0.26 vs. 2.48 ± 0.37, p < 0.01 for LPA), and significantly less requirement for HFOV (70 vs. 100 %, p < 0.05) and NO (20 vs. 86 %, p < 0.01). Four TR required conversion to OR for technical reasons (n = 3) and cardiopulmonary instability (n = 1). CONCLUSIONS: TR can be considered when RPA/LPA diameters are larger than 3.0/2.5 mm, respectively, and cardiopulmonary status is stable without NO.
Authors: Edmund Y Yang; Nikki Allmendinger; Sidney M Johnson; Catherine Chen; Jay M Wilson; Steven J Fishman Journal: J Pediatr Surg Date: 2005-09 Impact factor: 2.545
Authors: Merrill McHoney; Luca Giacomello; Shireen A Nah; Paolo De Coppi; Edward M Kiely; Joe I Curry; David P Drake; Simon Eaton; Agostino Pierro Journal: J Pediatr Surg Date: 2010-02 Impact factor: 2.545
Authors: S David Cho; Sanjay Krishnaswami; Julie C Mckee; Garret Zallen; Mark L Silen; David W Bliss Journal: J Pediatr Surg Date: 2009-01 Impact factor: 2.545