Document Detail


Dynamic tracheal occlusion improves lung morphometrics and function in the fetal lamb model of congenital diaphragmatic hernia.
MedLine Citation:
PMID:  21683214     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Eric B Jelin; Mozziyar Etemadi; Jose Encinas; Samuel C Schecter; Cheryl Chapin; Jianfeng Wu; Salvador Guevara-Gallardo; Amar Nijagal; Kelly D Gonzales; William T Ferrier; Shuvo Roy; Doug Miniati
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  46     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-20     Completed Date:  2011-10-31     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1150-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Surgery, Division of Pediatric Surgery, University of California, San Francisco, San Francisco, CA 94143, USA.
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Animals
Animals, Newborn
Disease Models, Animal
Endoscopes
Endoscopy / methods*
Equipment Design
Equipment Safety
Female
Fetal Diseases / surgery*
Hernia, Diaphragmatic / complications,  congenital*,  surgery
Hypertension, Pulmonary / etiology,  prevention & control*
Implants, Experimental*
Lung / embryology*,  growth & development
Pilot Projects
Pregnancy
Pregnancy, Animal
Random Allocation
Respiratory Function Tests
Risk Factors
Sensitivity and Specificity
Sheep
Trachea / surgery*
Grant Support
ID/Acronym/Agency:
F32 HL097400/HL/NHLBI NIH HHS; K08 HL092062/HL/NHLBI NIH HHS; K08 HL092062/HL/NHLBI NIH HHS; K08 HL092062-02/HL/NHLBI NIH HHS; K08 HL092062-03/HL/NHLBI NIH HHS; T32 GM008258/GM/NIGMS NIH HHS
Comments/Corrections

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