Cardiac anomalies in patients with congenital diaphragmatic hernia and their prognosis: a report from the Congenital Diaphragmatic Hernia Study Group
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Ductus arteriosus
Introduction: Morgagni hernias are anteromedial diaphragmatic defects that are typically simple to repair. As opposed to posterolateral defects, which are very difficult to expose laparoscopically, the anterior defects can be easily seen with this approach. We reviewed our experience with laparoscopic and open repair of Morgagni hernias in children and their associated outcomes. Materials and Methods: A retrospective review was conducted on all patients who underwent repair of Morgagni hernia from January 1994 to May 2009. Results: Seventeen patients were identified, of whom 9 underwent laparoscopic repair and 8 underwent an open repair. The mean age at operation was 3 years (newborn to 14 years) with a mean weight of 20.7 kg (3.6–87.6 kg). Intraoperatively, the diaphragmatic defect size in maximal dimension ranged from 3 to 11 cm. There was no difference in the average age, weight, and defect size among both groups. Of those who underwent laparoscopic hernia repair, 5 patients were closed with a Surgisis-Gold (SIS) patch, 1 was closed primarily with interrupted sutures, and 3 were closed with transabdominal sutures. In the open group, 7 were closed primarily and 1 required SIS patch for closure. Mean length of stay was 3.0 ± 1.5 days in the open group compared with 1.1 ± 0.4 days in the laparoscopic group (P < 0.01). There were no intraoperative complications and no recurrences. Conclusions: Laparoscopic repair of Morgagni hernias is a relatively simple and effective method of repair in children with accentuated advantages of minimally invasive surgery.
Hernia Repair
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Ductus arteriosus
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Survival is significantly compromised in infants born with congenital diaphragmatic hernia and major cardiac anomalies. Mortality is highest when congenital diaphragmatic hernia occurs in association with d-transposition of the great arteries. We present three infants with congenital diaphragmatic hernia associated with d-transposition of the great arteries from a single institution. All three infants survived to discharge after surgical repair/palliation of both the diaphragmatic hernia and heart defect and are doing well at last follow-up. The clinical course and management of these three patients are described.
Transposition (logic)
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A true diaphragmatic hernia is a congenital diaphragmatic malformation that can appear identical to a peritoneopericardial diaphragmatic hernia (PPDH). True diaphragmatic hernias are rare in dogs. Herein we describe the use of positive contrast peritoneography for diagnosis of a true diaphragmatic hernia in two dogs.
Diaphragm (acoustics)
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Abstract Administration of N, N'‐bis (dichloroacetyl)‐l,8‐octamethylenediamine, bisdiamine, to pregnant Donryu rats on a single day of gestation induced unilateral and bilateral diaphragmatic hernias in fetuses with high incidence. The protruded liver was not covered with a serous membrane or a muscular layer. Incidence of unilateral diaphragmatic hernia on the left side was high when bisdiamine was administered on day 9 or 13 of gestation, and that on the right side was high when administered on day 12 of gestation. Incidence of bilateral diaphragmatic hernia was high when bisdiamine was administered on day 12 of gestation. Differences in sensitivity to hernia formation according to day of bisdiamine administration between right and left sides may reflect differences in developmental chronology between the two sides. Two distinct times for induction of left diaphragmatic hernia might be attributed to at least two different mechanisms. The present model is expected to help analyzing not only anatomical characteristics of congenital diaphragmatic hernia but also possible mechanisms responsible for their development.
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Pulmonary Hypoplasia
Fetoscopy
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Congenital heart disease and congenital diaphragmatic hernia are frequently associated. The combination of these lesions is predictive of poor postnatal survival. The identification of both lesions during prenatal life may facilitate improved survival in carefully selected cases. We present a case of left-sided diaphragmatic hernia with transposition of the great arteries and a ventricular septal defect (VSD) that survived following repair of both defects within the first six weeks of life. Copyright © 2000 John Wiley & Sons, Ltd.
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This report describes a case of prenatally diagnosed bilateral diaphragmatic hernia. At 22 weeks' gestation, ultrasound revealed a cystic structure behind the fetus's heart on the axial image at the level of the cardiac four-chamber view. This suggested a left-sided congenital diaphragmatic hernia with herniation of the stomach into the left hemithorax. However, the left-to-right midline shift of the heart was minimal, which is not typical of left-sided congenital diaphragmatic hernia. Throughout the 30th week of gestation, the right and left branches of the pulmonary artery were hypoplastic compared with the values in normal fetuses of the same gestational age. The presumptive diagnosis was bilateral congenital diaphragmatic hernia. A female newborn weighing 2900 g was delivered at 37 weeks' gestation, and she died at 7 h of age. An autopsy revealed large defects on both sides of the diaphragm. In conclusion, prenatal diagnosis of bilateral diaphragmatic hernia is possible with fetal sonography.
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This report describes the evaluations of 2 patients with congenital diaphragmatic hernias using ultrasound (US). Identifying the size of the diaphragmatic defect is important when determining the type of surgical repair required. In case 1, the US evaluation of a Bochdalek hernia showed the rim of the anterolateral diaphragm; therefore, thoracoscopic primary repair was performed. In case 2, (Morgagni‐Larrey hernia), US revealed the left side of a retrosternal diaphragmatic hernia sac; therefore, thoracoscopic repair from the left thorax was performed. Ultrasound was useful for detecting the location and defect size of the diaphragmatic hernia and determining optimal surgical management.
Diaphragm (acoustics)
Thorax (insect anatomy)
Bochdalek hernia
Thoracoscopy
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