Development in lung function of the affected side after repair of congenital diaphragmatic hernia

The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

“…It has been known that pectus excavatum patients have slightly impaired pulmonary function, which may be due to decreased compliance of the chest wall [70]. It is hypothesized that reduced-lung tissue and consequent alveolar distension may result in early airway closure as found in the aging emphysematous lung, which could be an additional risk factor in the development of chronic obstructive disease on the longer term [48,71]. Some longterm follow-up studies indicate a higher incidence of restrictive lung function impairment among CDH patients compared to the healthy population [63,65] especially when there was a large diaphragmatic defect [65], while others cannot confirm this finding [59,66].…”

“…It has been demonstrated that in survivors of left side hernia repair, mean perfusion of the ipsilateral lung was lower than that in healthy children [48,[62][63][64][65] and in the contralateral lung [48,62,71]. Patients who were ventilated for 4 days or more had poorer perfusion than patients who had required shorter ventilatory support [48].…”

“…Patients who were ventilated for 4 days or more had poorer perfusion than patients who had required shorter ventilatory support [48]. Secondary lung injury may play an important role because ventilatory support and supplemental oxygen were required for a long period of time [71].…”

“…Presence of persistent pulmonary hypoperfusion on the side of the diaphragmatic defect suggests that an anatomic impairment of variable degree is still present several years after surgical repair in CDH patients and might reflect a limited ability of the ipsilateral lung to develop additional arterial branches [63,71]. It has been speculated that, because of persistence of poorly perfused ventilated areas representing dead space, these patients have increased intrapulmonary shunting and hypoxemia possibly leading to pulmonary hypertension [62].…”

“…Especially when the stomach initially was positioned in the chest, the lack of an intraabdominal esophageal segment following repair would adversely affect the angle of His [71,96]. The combination of increased abdominal-intrathoracal pressure gradient and underdevelopment of the diaphragmatic crus may increase the strain on the crus and result in an insufficient anti-reflux barrier [97] and favorable conditions for hiatus hernia and GERD [96,97].…”