Dynamic tracheal occlusion improves lung morphometrics and function in the fetal lamb model of congenital diaphragmatic hernia

Eric B. Jelin, Mozziyar Etemadi, Jose Encinas, Samuel C. Schecter, Cheryl Chapin, Jianfeng Wu, Salvador Guevara, Amar Nijagal, Kelly D. Gonzales, William T. Ferrier, Shuvo Roy, Doug Miniati

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Congenital diaphragmatic hernia (CDH) is associated with significant neonatal morbidity and mortality. Although prenatal complete tracheal occlusion (cTO) causes hypoplastic CDH lungs to enlarge, improved lung function has not been demonstrated. Furthermore, cTO interferes with the dynamic pressure change and fluid flow associated with fetal breathing. Purpose: The purpose of the study was to assess a novel dynamic tracheal occlusion (dTO) device that preserves pressure changes and fluid flow. Methods: In this pilot study, CDH was created in fetal lambs at 65 days of gestational age (GA). At 110 days GA, a cTO device (n = 3) or a dTO device (n = 4) was placed in the fetal trachea. At 135 days GA, lambs were delivered and resuscitated. Unoperated lamb co-twins (n = 5), sham thoracotomy lambs (n = 2), and untreated CDH lambs (n = 3) served as controls. Results: Tracheal opening pressure, lung volume, lung fluid total protein, and phospholipid were significantly higher in the cTO group than in the dTO and unoperated control groups. Maximal oxygenation and lung compliance were significantly lower in the cTO group when compared with the unoperated control and dTO groups. Conclusion: Preliminary results suggest that in the fetal lamb CDH model, dTO restores normal lung morphometrics and function, whereas cTO leads to enlarged but less functional lungs.

Original languageEnglish (US)
Pages (from-to)1150-1157
Number of pages8
JournalJournal of Pediatric Surgery
Volume46
Issue number6
DOIs
StatePublished - Jun 1 2011
Externally publishedYes

Fingerprint

Lung
Gestational Age
Pressure
Equipment and Supplies
Lung Compliance
Infant Mortality
Thoracotomy
Trachea
Congenital Diaphragmatic Hernias
Phospholipids
Respiration
Morbidity
Control Groups
Proteins

Keywords

  • Congenital diaphragmatic hernia
  • Lung
  • Pulmonary hypertension
  • Tracheal occlusion

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Dynamic tracheal occlusion improves lung morphometrics and function in the fetal lamb model of congenital diaphragmatic hernia. / Jelin, Eric B.; Etemadi, Mozziyar; Encinas, Jose; Schecter, Samuel C.; Chapin, Cheryl; Wu, Jianfeng; Guevara, Salvador; Nijagal, Amar; Gonzales, Kelly D.; Ferrier, William T.; Roy, Shuvo; Miniati, Doug.

In: Journal of Pediatric Surgery, Vol. 46, No. 6, 01.06.2011, p. 1150-1157.

Research output: Contribution to journalArticle

Jelin, EB, Etemadi, M, Encinas, J, Schecter, SC, Chapin, C, Wu, J, Guevara, S, Nijagal, A, Gonzales, KD, Ferrier, WT, Roy, S & Miniati, D 2011, 'Dynamic tracheal occlusion improves lung morphometrics and function in the fetal lamb model of congenital diaphragmatic hernia', Journal of Pediatric Surgery, vol. 46, no. 6, pp. 1150-1157. https://doi.org/10.1016/j.jpedsurg.2011.03.049
Jelin, Eric B. ; Etemadi, Mozziyar ; Encinas, Jose ; Schecter, Samuel C. ; Chapin, Cheryl ; Wu, Jianfeng ; Guevara, Salvador ; Nijagal, Amar ; Gonzales, Kelly D. ; Ferrier, William T. ; Roy, Shuvo ; Miniati, Doug. / Dynamic tracheal occlusion improves lung morphometrics and function in the fetal lamb model of congenital diaphragmatic hernia. In: Journal of Pediatric Surgery. 2011 ; Vol. 46, No. 6. pp. 1150-1157.
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abstract = "Background: Congenital diaphragmatic hernia (CDH) is associated with significant neonatal morbidity and mortality. Although prenatal complete tracheal occlusion (cTO) causes hypoplastic CDH lungs to enlarge, improved lung function has not been demonstrated. Furthermore, cTO interferes with the dynamic pressure change and fluid flow associated with fetal breathing. Purpose: The purpose of the study was to assess a novel dynamic tracheal occlusion (dTO) device that preserves pressure changes and fluid flow. Methods: In this pilot study, CDH was created in fetal lambs at 65 days of gestational age (GA). At 110 days GA, a cTO device (n = 3) or a dTO device (n = 4) was placed in the fetal trachea. At 135 days GA, lambs were delivered and resuscitated. Unoperated lamb co-twins (n = 5), sham thoracotomy lambs (n = 2), and untreated CDH lambs (n = 3) served as controls. Results: Tracheal opening pressure, lung volume, lung fluid total protein, and phospholipid were significantly higher in the cTO group than in the dTO and unoperated control groups. Maximal oxygenation and lung compliance were significantly lower in the cTO group when compared with the unoperated control and dTO groups. Conclusion: Preliminary results suggest that in the fetal lamb CDH model, dTO restores normal lung morphometrics and function, whereas cTO leads to enlarged but less functional lungs.",
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AU - Jelin, Eric B.

AU - Etemadi, Mozziyar

AU - Encinas, Jose

AU - Schecter, Samuel C.

AU - Chapin, Cheryl

AU - Wu, Jianfeng

AU - Guevara, Salvador

AU - Nijagal, Amar

AU - Gonzales, Kelly D.

AU - Ferrier, William T.

AU - Roy, Shuvo

AU - Miniati, Doug

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N2 - Background: Congenital diaphragmatic hernia (CDH) is associated with significant neonatal morbidity and mortality. Although prenatal complete tracheal occlusion (cTO) causes hypoplastic CDH lungs to enlarge, improved lung function has not been demonstrated. Furthermore, cTO interferes with the dynamic pressure change and fluid flow associated with fetal breathing. Purpose: The purpose of the study was to assess a novel dynamic tracheal occlusion (dTO) device that preserves pressure changes and fluid flow. Methods: In this pilot study, CDH was created in fetal lambs at 65 days of gestational age (GA). At 110 days GA, a cTO device (n = 3) or a dTO device (n = 4) was placed in the fetal trachea. At 135 days GA, lambs were delivered and resuscitated. Unoperated lamb co-twins (n = 5), sham thoracotomy lambs (n = 2), and untreated CDH lambs (n = 3) served as controls. Results: Tracheal opening pressure, lung volume, lung fluid total protein, and phospholipid were significantly higher in the cTO group than in the dTO and unoperated control groups. Maximal oxygenation and lung compliance were significantly lower in the cTO group when compared with the unoperated control and dTO groups. Conclusion: Preliminary results suggest that in the fetal lamb CDH model, dTO restores normal lung morphometrics and function, whereas cTO leads to enlarged but less functional lungs.

AB - Background: Congenital diaphragmatic hernia (CDH) is associated with significant neonatal morbidity and mortality. Although prenatal complete tracheal occlusion (cTO) causes hypoplastic CDH lungs to enlarge, improved lung function has not been demonstrated. Furthermore, cTO interferes with the dynamic pressure change and fluid flow associated with fetal breathing. Purpose: The purpose of the study was to assess a novel dynamic tracheal occlusion (dTO) device that preserves pressure changes and fluid flow. Methods: In this pilot study, CDH was created in fetal lambs at 65 days of gestational age (GA). At 110 days GA, a cTO device (n = 3) or a dTO device (n = 4) was placed in the fetal trachea. At 135 days GA, lambs were delivered and resuscitated. Unoperated lamb co-twins (n = 5), sham thoracotomy lambs (n = 2), and untreated CDH lambs (n = 3) served as controls. Results: Tracheal opening pressure, lung volume, lung fluid total protein, and phospholipid were significantly higher in the cTO group than in the dTO and unoperated control groups. Maximal oxygenation and lung compliance were significantly lower in the cTO group when compared with the unoperated control and dTO groups. Conclusion: Preliminary results suggest that in the fetal lamb CDH model, dTO restores normal lung morphometrics and function, whereas cTO leads to enlarged but less functional lungs.

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