Dynamic tracheal occlusion improves lung morphometrics and function in the fetal lamb model of congenital diaphragmatic hernia |
| |
Authors: | Jelin Eric B Etemadi Mozziyar Encinas Jose Schecter Samuel C Chapin Cheryl Wu Jianfeng Guevara-Gallardo Salvador Nijagal Amar Gonzales Kelly D Ferrier William T Roy Shuvo Miniati Doug |
| |
Institution: | a Surgery, Division of Pediatric Surgery, University of California, San Francisco, San Francisco, CA 94143, USAb UC Berkeley and UCSF Joint Program in Bioengineering, San Francisco, CA 94143, USAc Pediatric Surgery, La Paz Hospital, Madrid 28046, Spaind Pediatrics, Division of Neonatology, University of California, San Francisco, CA 94143, USAe Campus Veterinary Services, University of California, Davis, CA 95616, USA |
| |
Abstract: | BackgroundCongenital 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.PurposeThe purpose of the study was to assess a novel dynamic tracheal occlusion (dTO) device that preserves pressure changes and fluid flow.MethodsIn 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.ResultsTracheal 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.ConclusionPreliminary 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. |
| |
Keywords: | Congenital diaphragmatic hernia Tracheal occlusion Lung Pulmonary hypertension |
本文献已被 ScienceDirect PubMed 等数据库收录! |
|