PMID- 18405706
OWN - NLM
STAT- MEDLINE
DCOM- 20080613
LR  - 20080414
IS  - 1531-5037 (Electronic)
IS  - 0022-3468 (Linking)
VI  - 43
IP  - 4
DP  - 2008 Apr
TI  - Main bronchus occlusion for treatment of congenital diaphragmatic hernia in fetal 
      lambs.
PG  - 620-6
LID - 10.1016/j.jpedsurg.2007.09.071 [doi]
AB  - PURPOSE: The present study investigates a new surgical approach in the treatment 
      of left diaphragmatic hernia in fetal sheep. We postulated that unlike tracheal 
      occlusion where both lungs are occluded, selective left main bronchus occlusion 
      (LMBO) would accelerate growth of only the left lung, reduce left visceral 
      herniation, and recover space in the both thoraces necessary for lung 
      development. METHODS: Left-sided congenital diaphragmatic hernia (CDH) was 
      surgically created in 8 fetal lambs at approximately 65 days of gestation; in 4 
      of these animals, LMBO was performed at approximately 118 days. Four 
      sham-operated animals served as controls. Lambs were delivered by hysterotomy at 
      137 days. We measured lung-to-body weight ratios, alveolar surface area, septal 
      wall thickness, and AE2 cell density in the left and right lungs. RESULTS: Left 
      main bronchus occlusion increased (P < .05) left lung growth causing severe right 
      mediastinal shift but failed to reduce herniated abdominal viscera in 3 of 4 
      lambs. Wet lung-to-body weight ratio in LMBO group was similar to that of the 
      control group; however, this was achieved by overgrowth of left lung, whereas the 
      right wet lung-to-body weight ratio remained low. In the LMBO group, right lung 
      AE2 cell density was higher than that of control group and not different to that 
      of the CDH group. CONCLUSIONS: Left main bronchus occlusion failed to restore 
      normal pulmonary development in CDH.
FAU - Biard, Jean-Marc
AU  - Biard JM
AD  - The Center for Fetal Diagnosis and Treatment at The Children's Hospital of 
      Philadelphia, PA 19104-4399, USA.
FAU - Schwarz, Uwe
AU  - Schwarz U
FAU - Davey, Marcus G
AU  - Davey MG
FAU - Danzer, Enrico
AU  - Danzer E
FAU - Johnson, Mark P
AU  - Johnson MP
FAU - Flake, Alan W
AU  - Flake AW
FAU - Adzick, Scott N
AU  - Adzick SN
FAU - Hedrick, Holly L
AU  - Hedrick HL
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
SB  - IM
MH  - Animals
MH  - Bronchoconstriction
MH  - Hernia, Diaphragmatic/*embryology/pathology/*surgery
MH  - Lung/*embryology/growth & development/*pathology
MH  - Organ Size
MH  - Sheep
EDAT- 2008/04/15 09:00
MHDA- 2008/06/14 09:00
CRDT- 2008/04/15 09:00
PHST- 2007/06/07 00:00 [received]
PHST- 2007/09/19 00:00 [revised]
PHST- 2007/09/19 00:00 [accepted]
PHST- 2008/04/15 09:00 [pubmed]
PHST- 2008/06/14 09:00 [medline]
PHST- 2008/04/15 09:00 [entrez]
AID - S0022-3468(07)00741-5 [pii]
AID - 10.1016/j.jpedsurg.2007.09.071 [doi]
PST - ppublish
SO  - J Pediatr Surg. 2008 Apr;43(4):620-6. doi: 10.1016/j.jpedsurg.2007.09.071.