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Annals of the American Thoracic Society Nov 2020Brain-type natriuretic peptide (BNP) correlates with pulmonary hypertension as demonstrated by echocardiogram in congenital diaphragmatic hernia (CDH); however, its...
Brain-type natriuretic peptide (BNP) correlates with pulmonary hypertension as demonstrated by echocardiogram in congenital diaphragmatic hernia (CDH); however, its association with right ventricular (RV) function and mortality is unknown. To characterize the relationships between echocardiogram-derived RV strain, BNP, and mortality in diaphragmatic hernia. We performed a single-center retrospective cohort study of infants with CDH and at least one BNP-echocardiogram pair within a 24-hour period. RV global longitudinal strain (GLS) and free-wall strain (FWS) were measured on existing echocardiograms. Associations among strain, BNP, and mortality were tested using mixed-effect linear and logistic regression models. Survival analysis was stratified by BNP and strain abnormalities. There were 220 infants with 460 BNP-echocardiogram pairs obtained preoperatively ( = 237), ≤1 week postoperatively ( = 35), and >1 week postoperatively ("recovery"; = 188). Strain improved after repair ( < 0.0001 for all periods). Higher BNP level was associated with worse strain in recovery but not before or immediately after operation (estimate [95% confidence interval] for recovery: GLS, 1.03 [0.50-1.57]; = 0.0003; FWS, 0.62 [0.01-1.22]; = 0.047). BNP and strain abnormalities were associated with an extracorporeal-membrane oxygenation requirement. Higher BNP level in recovery was associated with greater mortality (odds ratio, 11.2 [1.2-571.3]; = 0.02). Abnormal strain in recovery had high sensitivity for detection of mortality (100% for GLS; 100% for FWS) but had low specificity for detection of mortality (28% for GLS; 48% for FWS). Persistent RV dysfunction after CDH repair may be detected by a high BNP level and abnormal RV strain.
Topics: Heart Ventricles; Hernias, Diaphragmatic, Congenital; Humans; Infant; Natriuretic Peptide, Brain; Retrospective Studies; Ventricular Dysfunction, Right
PubMed: 32730099
DOI: 10.1513/AnnalsATS.201910-767OC -
Surgical Endoscopy Jan 2022Currently, there is a relative paucity of literature regarding the management of symptomatic congenital diaphragmatic hernia of the foramen of Morgagni in the adult....
BACKGROUND
Currently, there is a relative paucity of literature regarding the management of symptomatic congenital diaphragmatic hernia of the foramen of Morgagni in the adult. This study aims to describe our unique surgical technique and outcomes in adult patients undergoing laparoscopic repair of symptomatic Morgagni hernia.
METHODS
This is a retrospective review of adult patients from 2003 to 2020 who underwent a laparoscopic Morgagni hernia repair at our institution. All patients underwent a similar laparoscopic approach, utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect and mesh reinforcement with permanent mesh if the primary repair was subjectively under tension.
RESULTS
The study population consisted of 12 consecutive patients with a Morgagni hernia. Patients presented with a variety of symptoms attributed to the hernia, including pain 83% (n = 10), respiratory symptoms and shortness of breath 58% (7), and gastrointestinal obstruction 25% (3). Other complaints included: nausea 33% (4), reflux 50% (6), early satiety 8% (1), palpitations 16% (2), a gurgling sensation in the chest 8% (1), and weight loss 8% (1). Primary repair was possible in all patients following complete reduction of hernia contents including the hernia sac. Mesh reinforcement was used in 5 of 12 patients. Average surgical operative time was 93 (± 37) min. Median length of stay was 1.3 days (range 0.5-5.5 days). At a median follow-up of 10.9 months (IQR 8.0-41.5 months), all symptoms attributed to the hernia had resolved. No recurrences were identified.
CONCLUSIONS
Adults with symptomatic Morgagni hernia should undergo surgical repair. A laparoscopic approach utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect (when possible), with or without mesh reinforcement can be performed safely and effectively.
Topics: Adult; Hernias, Diaphragmatic, Congenital; Herniorrhaphy; Humans; Laparoscopy; Operative Time; Surgical Mesh
PubMed: 33438077
DOI: 10.1007/s00464-020-08259-z -
BMC Pediatrics Mar 2021To evaluate the long-term functional and structural pulmonary development in children with repaired congenital diaphragmatic hernia (CDH) and to identify the associated...
BACKGROUND
To evaluate the long-term functional and structural pulmonary development in children with repaired congenital diaphragmatic hernia (CDH) and to identify the associated perinatal-neonatal risk factors.
METHODS
Children with repaired CDH through corrective surgery who were born at gestational age ≥ 35 weeks were included in this analysis. Those who were followed for at least 5 years were subjected to spirometry and chest computed tomography for evaluation of their functional and structural growth. Main bronchus diameters and lung volumes (total, left/right) were measured. According to total lung volume (TLV) relative to body surface area, children were grouped into TLV ≥ 50 group and TLV < 50 group and the associations with perinatal-neonatal factors were analyzed.
RESULTS
Of the 28 children (mean age, 6.2 ± 0.2 years) with left-sided CDH, 7 (25%) had abnormal pulmonary function, of whom 6 (87%) showed restrictive patterns. All pulmonary functions except FEF25-75% were worse than those in matched healthy control group. Worse pulmonary function was significantly associated with small head and abdominal circumferences at birth. The mean TLV was 1339.1 ± 363.9 mL and LLV/TLV was 47.9 ± 2.5 mL. Children with abnormal pulmonary function were more likely to have smaller lung volumes. In multivariate analysis, abdominal circumference at birth was significantly associated with abnormal lung volume.
CONCLUSIONS
A quarter of children with repaired CDH showed abnormal pulmonary function. Small abdominal circumference at birth was associated with abnormal pulmonary function and lower TLV. .
Topics: Child; Female; Gestational Age; Hernias, Diaphragmatic, Congenital; Humans; Infant; Infant, Newborn; Lung; Lung Volume Measurements; Pregnancy
PubMed: 33706730
DOI: 10.1186/s12887-021-02586-3 -
European Journal of Pediatrics Aug 2022
Topics: Hernias, Diaphragmatic, Congenital; Humans; Lung Compliance; Respiratory Mechanics
PubMed: 35695953
DOI: 10.1007/s00431-022-04520-w -
Operative Neurosurgery (Hagerstown, Md.) Nov 2022The creation of sagittal balance of the spine is critical in the treatment adult spinal deformity. Anterior column release (ACR) has gained traction as a minimally...
BACKGROUND
The creation of sagittal balance of the spine is critical in the treatment adult spinal deformity. Anterior column release (ACR) has gained traction as a minimally invasive alternative to pedicle subtraction osteotomy. By releasing the anterior longitudinal ligament, the anterior column can be lengthened and physiologic lordosis restored. Risks such as transient psoas weakness and thigh numbness have been well documented in the literature; however, diaphragmatic hernia has never been reported.
OBJECTIVE
To highlight the difficulties encountered in diagnosing, managing, and treating iatrogenic diaphragmatic hernia in the setting of ACR and stress the relevant retropleural, retroperitoneal, and diaphragmatic structures during the surgical approach.
METHODS
In this technical note, we discuss the relevant anatomy in a direct lateral approach to the thoracolumbar junction and the management of an iatrogenic diaphragmatic hernia, which occurred in a patient who underwent a L1 ACR.
RESULTS
Three months after surgery, our patient was assessed in clinic and endorsed significant improvements in her pain and mobility. Her 3-month postoperative scoliosis x-rays demonstrated a significant improvement in her sagittal alignment, and she experienced no further negative sequelae from the iatrogenic hernia.
CONCLUSION
Iatrogenic diaphragmatic hernia with an intrathoracic spleen after direct lateral ACR is a risk spine surgeons should be aware of and address promptly.
Topics: Adult; Female; Hernia, Diaphragmatic; Humans; Iatrogenic Disease; Osteotomy; Retrospective Studies; Spinal Fusion; Spleen; Treatment Outcome
PubMed: 36227227
DOI: 10.1227/ons.0000000000000371 -
The Israel Medical Association Journal... Feb 2022
Topics: Elasticity; Hernia, Diaphragmatic; Herniorrhaphy; Humans; Laparoscopy; Male; Skin Diseases; Young Adult
PubMed: 35187904
DOI: No ID Found -
Archivos Argentinos de Pediatria Jun 2020Congenital diaphragmatic hernia (CDH) prevalence is low while its associated morbidity and mortality rates are high. Postnatal prognostic factors on the first day of... (Observational Study)
Observational Study
INTRODUCTION
Congenital diaphragmatic hernia (CDH) prevalence is low while its associated morbidity and mortality rates are high. Postnatal prognostic factors on the first day of life are useful for predicting the outcome.
OBJECTIVES
To determine the mortality predictive ability of postnatal echocardiographic, clinical, and biochemical factors among newborn infants with CDH in their first day of life.
METHOD
Observational analytical study of a retrospective cohort. Patients with CDH were consecutively included between March 2012 and November 2018. On the first day of life, analyzed predictors were the oxygenation index (OI), the highest partial pressure of carbon dioxide (pCO2) level in blood, the SNAPPE II severity score, the echocardiography, and the N-terminal pro-B-type natriuretic peptide (NTproBNP) value.
RESULTS
The population consisted of 178 patients with CDH. Survival was 75 %. Extracorporeal membrane oxygenation was used in 24 %. The early onset of systemic or suprasystemic pulmonary hypertension showed no predictive ability (OR: 2.2, 95 % CI: 0.8-8), p = 0.1. NT-proBNP did not show good discrimination either (area under the curve [AUC]: 0.46, p = 0.67). The OI, SNAPPE II score, and the highest pCO2 level showed adequate discrimination power, AUC for OI: 0.82, AUC for SNAPPE II: 0.86, and AUC for pCO2: 0.75, p < 0.001.
CONCLUSION
The SNAPPE II score, the OI, and the highest pCO2 level measured on the first day of life, showed a good predictive ability in terms of the course of the disease; the SNAPPE II score was better than the OI and the highest pCO2 level.
Topics: Biomarkers; Clinical Decision Rules; Echocardiography; Extracorporeal Membrane Oxygenation; Female; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Male; Prognosis; Retrospective Studies; Severity of Illness Index
PubMed: 32470252
DOI: 10.5546/aap.2020.eng.173 -
Functional & Integrative Genomics Jun 2022Congenital diaphragmatic hernia (CDH) is an anomaly characterized by a defect in the diaphragm, leading to the passage of intra-abdominal organs into the thoracic...
Congenital diaphragmatic hernia (CDH) is an anomaly characterized by a defect in the diaphragm, leading to the passage of intra-abdominal organs into the thoracic cavity. Herein, the presented work analyzes the global gene expression profiles in nine CDH and one healthy newborn. All of the patients had left posterolateral (Bochdalek) diaphragmatic hernia, operated via an abdominal approach, and stomach and bowels in the thorax cavity. Some patients also had additional anomalies. A total of 560 differentially regulated genes were measured. Among them, 11 genes showed significant changes in expression associated with lung tissue, vascular structure development, and vitamin A metabolism, which are typical ontologies related to CDH etiology. Among them, SLC25A24 and RAB3IL1 are involved in angiogenesis, HIF1A and FOXC2-AS1 are related with the alveolus, MAGI2-AS3 is associated with the diaphragm, LHX4 and DHH are linked with the lung, and BRINP1, FZD9, WNT4, and BLOC1S1-RDH5 are involved in retinol. Besides, the expression levels of some previously claimed genes with CDH etiology also showed diverse expression patterns in different patients. All these indicated that CDH is a complex, multigenic anomaly, requiring holistic approaches for its elucidation.
Topics: Diaphragm; Gene Expression Profiling; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Microarray Analysis; Nerve Tissue Proteins
PubMed: 35260975
DOI: 10.1007/s10142-022-00837-9 -
Journal of Pediatric Surgery Apr 2022As survival rates for patients with congenital diaphragmatic hernia (CDH) increase, long-term sequelae become increasingly prevalent. We present the outcomes of patients...
BACKGROUND/PURPOSE
As survival rates for patients with congenital diaphragmatic hernia (CDH) increase, long-term sequelae become increasingly prevalent. We present the outcomes of patients who underwent CDH repair at our institution and discuss standardization of follow-up care in our long-term multidisciplinary follow-up clinic.
METHODS
A retrospective review of patients followed in multidisciplinary clinic after CDH repair at our institution from January 1, 2005 to December 1, 2020.
RESULTS
A total of 193 patients met inclusion criteria, 73 females (37.8%) and 120 males (62.2%). Left-sided defects were most common (75.7%), followed by right-sided defects (20.7%). Median age at repair was 4 days (IQR 3-6) and 59.6% of all defects required patch repair. Median length of stay was 29 days (IQR 16.8-50.0). Median length of follow up was 49 months (IQR 17.8-95.3) with 25 patients followed for more than 12 years. Long-term outcomes included gastroesophageal reflux disease (42.0%), diaphragmatic hernia recurrence (10.9%), asthma (23.6%), neurodevelopmental delay (28.6%), attention deficit hyperactivity disorder (7.3%), autism (1.6%), chest wall deformity (15.5%), scoliosis (11.4%), and inguinal hernia (6.7%).
CONCLUSION
As survival of patients with CDH improves, long-term care must be continuously studied and fine-tuned to ensure appropriate surveillance and optimization of long-term outcomes.
Topics: Female; Hernias, Diaphragmatic, Congenital; Herniorrhaphy; Humans; Male; Retrospective Studies; Scoliosis; Thoracic Wall; Treatment Outcome
PubMed: 34274078
DOI: 10.1016/j.jpedsurg.2021.06.007 -
Scandinavian Journal of Gastroenterology Nov 2022Congenital diaphragmatic hernias (CDHs) in adults remain rare, with limited data on them available. However, CDHs can cause respiratory and gastrointestinal symptoms in...
INTRODUCTION
Congenital diaphragmatic hernias (CDHs) in adults remain rare, with limited data on them available. However, CDHs can cause respiratory and gastrointestinal symptoms in adults, even resulting in the strangulation of the bowel when incarcerated. Here, we aimed to analyze surgical outcomes among adult patients. The primary outcome of interest was the complication rate, reoperations and 90-day mortality after laparoscopic and open hernia repair.
METHODS
We identified all adult patients diagnosed with a Morgagni or Bochdalek hernia treated operatively between 2010 and 2019 in a single tertiary care hospital. Data on patient demographics, surgical characteristics, mortality and morbidity were collected.
RESULTS
In total, we identified 37 patients (67.6% female; average age, 57 years). Overall, 78.4% patients underwent minimally invasive operations, while 35.1% underwent emergency operations. A Clavien-Dindo grade II-V complication was experienced by 18.9% of patients. No deaths occurred within 90 days of surgery, and we detected no recurrences in short-term or long-term follow-up. A minimally invasive technique correlated with a shorter hospital stay of 3.6 days versus 6.8 days in the open surgery group ( = .007, = 3.3, 95% confidence interval = 1.04-5.21).
CONCLUSION
Our findings indicate that the laparoscopic repair of a congenital diaphragmatic hernia is safe and effective, offering short hospital stay and a low amount of complications.
Topics: Adult; Humans; Female; Middle Aged; Male; Hernias, Diaphragmatic, Congenital; Laparoscopy; Minimally Invasive Surgical Procedures; Reoperation; Length of Stay
PubMed: 35658774
DOI: 10.1080/00365521.2022.2081818