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Pulmonary artery size as an indication for thoracoscopic repair of congenital diaphragmatic hernia in neonates

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Abstract

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.

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Authors and Affiliations

  1. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Tadaharu Okazaki, Hiroyuki Koga, Go Miyano, Manabu Okawada, Geoffrey J. Lane & Atsuyuki Yamataka

  2. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan

    Tadaharu Okazaki

  3. Department of Anesthesiology, Juntendo University School of Medicine, Tokyo, Japan

    Kinya Nishimura & Eiichi Inada

  4. Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan

    Hiromichi Shoji & Toshiaki Shimizu

  5. Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan

    Shintaro Makino & Satoru Takeda

Authors
  1. Tadaharu Okazaki
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  2. Kinya Nishimura
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  3. Hiroyuki Koga
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  4. Go Miyano
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  5. Manabu Okawada
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  6. Hiromichi Shoji
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  7. Toshiaki Shimizu
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  8. Shintaro Makino
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  9. Satoru Takeda
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  10. Eiichi Inada
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  11. Geoffrey J. Lane
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  12. Atsuyuki Yamataka
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Corresponding author

Correspondence to Tadaharu Okazaki.

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Okazaki, T., Nishimura, K., Koga, H. et al. Pulmonary artery size as an indication for thoracoscopic repair of congenital diaphragmatic hernia in neonates. Pediatr Surg Int 28, 883–886 (2012). https://doi.org/10.1007/s00383-012-3148-9

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  • DOI: https://doi.org/10.1007/s00383-012-3148-9

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