Ventricular Dysfunction is a Critical Determinant of Mortality in Congenital Diaphragmatic Hernia.

Ventricular Dysfunction is a Critical Determinant of Mortality in Congenital Diaphragmatic Hernia. Am J Respir Crit Care Med. 2019 Aug 13;: Authors: Patel N, Lally PA, Kipfmueller F, Massolo AC, Luco M, Van Meurs KP, Lally KP, Harting MT, Congenital Diaphragmatic Hernia Study Group Abstract RATIONALE Congenital diaphragmatic hernia (CDH) is an anomaly with a high morbidity and mortality. Cardiac dysfunction may be an important and under-recognized contributor to CDH pathophysiology and determinant of disease severity. OBJECTIVES To investigate the association between early, postnatal ventricular dysfunction and outcome among infants with CDH. METHODS Multicenter, prospectively-collected data in the Congenital Diaphragmatic Hernia Study Group (CDHSG) registry, abstracted between 2015 and 2018, were evaluated. Ventricular function on early echocardiograms, obtained within the first 48 hours of life, was categorized into four hierarchical groups: normal function, right ventricular dysfunction only (RVdys), left ventricular dysfunction only (LVdys), and combined RV and LV dysfunction (RV&LVdys). Univariate, multivariate, and Cox proportional hazards regression analyses were performed. MEASUREMENT AND MAIN RESULTS Cardiac function data from early echocardiograms were available for 1173 (71%) cases and categorized as normal in 711 (61%), RVdys in 182 (15%), LVdys in 61 (5%), and combined RV&LVdys in 219 (19%) cases. Ventricular dysfunction was significantly as...
Source: American Journal of Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Am J Respir Crit Care Med Source Type: research

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Conclusion The available data point toward improved recovery in pediatric video-assisted thoracoscopic surgery despite longer operative times. Further randomized controlled trials are needed to justify the widespread use of video assisted thoracoscopy in pediatric surgery. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: European Journal of Pediatric Surgery - Category: Surgery Authors: Tags: Original Article Source Type: research
Congenital diaphragmatic hernia is a pathology most often affecting the pediatric population, though can go undetected into adulthood. Few studies exist of adults undergoing repair of this defect. Using a national database, we sought to determine demographics and outcomes of this population.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: General Surgery Source Type: research
This study sought to identify factors contributing to hospital readmission after CDH repair.
Source: Journal of Pediatric Surgery - Category: Surgery Authors: Source Type: research
ConclusionOur study suggests that in infants with CDH, there is no significant difference between HFV and CMV in oxygen dependency or death.
Source: Pediatric Surgery International - Category: Surgery Source Type: research
Abstract BACKGROUND: A genetic disorder should be considered when an infant presents with multiple congenital anomalies. Because of the acute presentation of an infant with multiple life-threatening defects, a genetic diagnosis of a rare disorder took weeks to delineate. CLINICAL FINDINGS: This case describes a late preterm infant who presented at birth with congenital diaphragmatic hernia, tetralogy of Fallot, cleft lip, low-set ears, and hypertelorism. PRIMARY DIAGNOSIS: Donnai-Barrow syndrome was the final diagnosis confirmed by a defect observed on the LRP2 (2q31.1) gene using sequence analysis. This...
Source: Advances in Neonatal Care - Category: Nursing Authors: Tags: Adv Neonatal Care Source Type: research
Conclusion: Patients without a true defect seem to have a more similar clinical outcome than CDH patients with a true defect, with a better survival. However, the recurrence rate and duration of oxygen supplementation at 30  days are higher than CDH patients with a true defect.What is Known:• Congenital diaphragmatic hernia with or without hernia sac and congenital diaphragmatic eventration (incomplete muscularization) are often treated similarly.• Patients with hernia sac and eventration are thought to have a relatively good outcome, but exact numbers are not described.What is New:• Congenital diaphrag...
Source: European Journal of Pediatrics - Category: Pediatrics Source Type: research
This study aims to determine the contribution different medical and surgical treatments have had on the development of surgical complications.MethodAll CDH patients treated in a single centre between 2000 and 2015 were retrospectively evaluated. Multivariate logistic regression was used to estimate the independent effects of several treatment options that could influence the surgical outcome by adjustment for multiple risk factors.ResultsSixty of the 197 surgically repaired CDH patients had surgical complications. There were more haemorrhagic complications in the ECMO compared to non-ECMO group (27% vs. 2%,p 
Source: World Journal of Surgery - Category: Surgery Source Type: research
The diaphragm, which forms a physical barrier between the thoracic and the abdominal cavities, is also the major part of the respiratory system. Congenital diaphragmatic hernia (CDH) is a malformation of that partition muscle. Expanded polytetrafluoroethylene (e-PTFE), a synthetic nondegradable biomaterial, is currently used for the repair of diaphragm defects. Indeed, this hydrophobic biomaterial does not promote rapid and dense cell colonization. Surface modifications are needed to favor or even guide cellular responses.
Source: Journal of Surgical Research - Category: Surgery Authors: Tags: Pediatric/Congenital/Developmental Source Type: research
Eur J Pediatr Surg DOI: 10.1055/s-0040-1702222The surgical management of patients with congenital diaphragmatic hernia (CDH) is challenging and ever changing. It requires the highest expertise not only on the surgical level but also of neonatologists and anesthesiologists. In selected patients traditional open surgery is increasingly replaced by thoracoscopic CDH repair in many centers worldwide. Despite obvious and well-described advantages of the minimally invasive approach like a shorter ventilatory time, less pain, a shorter hospital length of stay, and a better cosmesis, important controversies remain. This review dis...
Source: European Journal of Pediatric Surgery - Category: Surgery Authors: Tags: Review Article Source Type: research
ConclusionsBoth muscle flap and patch repair of large CDH are feasible and durable with a relatively low risk of recurrence.
Source: Pediatric Surgery International - Category: Surgery Source Type: research
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