Postoperative pulmonary vascular growth in patients with congenital diaphragmatic hernia
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In brief
In brief
This retrospective study of 21 CDH patients demonstrates postoperative improvement in ipsilateral lung vascular growth using serial perfusion scintigraphy over 3.6 years. Thoracoscopic repair showed significantly greater lung perfusion improvement compared to open abdominal approach, suggesting minimally invasive techniques may enhance pulmonary vascular development.
- Ipsilateral lung perfusion improves postoperatively in CDH patients, with median increase of 7% over 3+ years follow-up.
- Early disease severity (gestational age at diagnosis, A-aDO2 at birth, preoperative NO use) predicts initial lung perfusion.
- Thoracoscopic repair shows greater long-term perfusion improvement vs open abdominal approach (+10.6% vs +4.25%, p=0.042).
- Postoperative vascular growth occurs regardless of initial severity markers (A-aDO2, NO use, liver herniation).
- Serial lung perfusion scintigraphy effectively tracks pulmonary vascular development in CDH survivors.
Written by the GCMD Library team from the article.
Abstract
Background
Postoperative pulmonary growth in congenital diaphragmatic hernias (CDH) remains unclear. We investigated postoperative pulmonary vascular growth using serial lung perfusion scintigraphy in patients with CDH.
Methods
Neonates with left CDH who underwent surgery and postoperative lung perfusion scintigraphy at our institution between 2001 and 2020 were included. Patient demographics, clinical courses, and lung scintigraphy data were retrospectively analyzed by reviewing medical records.
Results
Twenty-one patients with CDH were included. Of these, 10 underwent serial lung scintigraphy. The ipsilateral perfusion rate and median age on the 1st and serial lung scintigraphy were 32% (34 days) and 33% (3.6 years), respectively. Gestational age at prenatal diagnosis (p = 0.02), alveolar–arterial oxygen difference (A-aDO2) at birth (p = 0.007), and preoperative nitric oxide (NO) use (p = 0.014) significantly correlated with the 1st lung scintigraphy. No other variables, including operative approach, were significantly correlated with the 1st or serial scintigraphy findings.
All patients improved lung perfusion with serial studies [Difference: + 7.0 (4.3–13.25) %, p = 0.001, paired t-test]. This improvement was not significantly correlated with preoperative A-aDO2 (p = 0.96), NO use (p = 0.28), or liver up (p = 0.90). The difference was significantly larger in patients who underwent thoracoscopic repair than in those who underwent open abdominal repair [+ 10.6 (5.0–17.1) % vs. + 4.25 (1.2–7.9) %, p = 0.042].
Conclusion
Our study indicated a postoperative improvement in ipsilateral lung vascular growth, which is possibly enhanced by a minimally invasive approach, in patients with CDH.