Congenital diaphragmatic hernia

[size=6]You are performing a repair of a large congenital diaphragmatic hernia on an infant who is on ECMO. The hernia is not amenable to a primary repair, so you opt to perform a muscle-flap repair. When compared to patch repairs performed while on ECMO, you would expect which of the following outcomes? a Longer operative time b Reduced post-op PRBC transfusions c Reduced time on ECMO d Increased risk of hernia recurrence e Increased reoperations for bleeding[/size]

[size=20px]A three-kg term infant with prenatally identified congenital diaphragmatic hernia (CDH) is on high frequency oscillation ventilation. Persistent pulmonary hypertension and evidence of left ventricular dysfunction is noted on echocardiogram. Addition of which of the following pharmacologic agents is the best next step in management for this child? a Treprostinil b Sodium Nitroprusside c Milrinone d Sildenafil e Inhaled Nitric Oxide[/size]

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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "After the hernia is reduced, an attempt is made to visualize the ipsilateral lung. This is usually done by retracting the anterior rim of the diaphragm. Often, a hypoplastic lung can be observed at the apex. A hernial sac, composed of pleura and peritoneum, is present in about 20% of patients. The sac, if present, is excised to avoid leaving a loculated, space-occupying lesion in the chest"

Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Three easily detectable features—polyhydramnios, mediastinal shift, and the absence of an intra-abdominal stomach bubble—should prompt a more careful search for herniated abdominal organs in the chest. Polyhydramnios is present in about 80% of the pregnancies with fetuses who have CDH and has also been associated with poor outcome. Routine antenatal ultrasound detects approximately 50–85% of cases of CDH. Lung-to-head ratio (LHR), the ratio of contralateral lung area to head circumference, measured by antenatal ultrasound, is used to predict the severity and outcome in CDH and…

[size=20px]An eleven month old infant with a history of CDH repaired with a patch returns to a follow-up clinic with poor weight gain, persistent cough, and a normal CXR. What is the next best step in this infant’s management? A Change formula B Video fluoroscopic swallow study C Laparoscopic Nissen fundoplication D Placement gastrostomy tube [/size]

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[center]Thoracoscopic repair of left Bochdalek hernia. See video in 2nd post[/center]

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Thoracoscopic diaphragmatic plication. See video in 2nd post

[center]Laparoscopic assisted repair of Morgagni hernia See video in 2nd post[/center]

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An 18-mo old boy with trisomy 21 presents with 3 days of cough,fever,and congestion.His temperature is 39 C. Rest of vital signs normal. He has diffuse lung rhonchi, and a normal abdomen.O2 saturation on room air 97%.Chest x-ray shown. How would you manage?