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Congenital Diaphragmatic Hernia & Eventration Of Diaphragm Dr.V.N.Mahalakshmi.

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Presentation on theme: "Congenital Diaphragmatic Hernia & Eventration Of Diaphragm Dr.V.N.Mahalakshmi."— Presentation transcript:

1 Congenital Diaphragmatic Hernia & Eventration Of Diaphragm Dr.V.N.Mahalakshmi

2 Development of diaphragm Tissues of origin Septum transversum Esophageal mesentry Mesoderm from body wall Lumbar somites

3 Development of diaphragm

4 Pathology of CDH Failure of closure of pleuro-peritoneal canal Most common area is a postero-lateral defect ( Bochdalek ) Left side more common

5 Pathology of CDH Diaphragmatic defect Abdominal viscera fill the chest cavity Abdomen small & poorly developed

6 Pathology of CDH Both lungs hypoplastic More so on the ipsilateral side Pulmonary vessels hypoplastic PPHN

7 Pathology of CDH Following delivery Bowels fill with air Compression of ipsilateral lung Mediastinal shift Compression of contralateral lung mechanical compression of lung

8 Pathology of CDH Lung hypoplasia PPHN Mechanical compression Respiratory distress

9 Lung development in CDH No. of bronchial branches – greatly reduced Alveolar development severely affected Increased muscle mass in the conducting airways Seen in contra lateral lung too

10 Pulmonary vasculature in CDH Reduction in the total no. of branches Both in ipsilateral and contra lateral lungs Significant adventitial and medial wall thickening Increased susceptibility to PPH hypoxia, acidosis, hypothermia, stress

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13 Persistent fetal circulation pulmonary artery resistance pulmonary artery pressures pulmonary vascular flow Right to left shunting Hypoxia & Progressive desaturation Respiratory failure

14 Diagnosis CXR diagnostic Absence of diaphragm Scaphoid abdomen Bowel loops in chest Mediastinal shift

15 Chest X - Ray

16 Problems Hypoxia Respiratory distress Metabolic acidosis Hypercarbia

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18 Treatment Initial goal Stabilisation of respiration Treatment of PPHN

19 Treatment Oxygenation & mechanical ventilation Correction of PPHN (NO / Vasodilators ) Correction of metabolic acidosis

20 Treatment Surgical repair of the defect Abdominal approach Post-op ventilation

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22 Newer advances in therapy In utero repair PLUG therapy ECMO

23 Prenatal diagnosis 16 weeks Herniated viscera in the chest Mediastinal shift to opposite side Stomach in the chest Associated anomalies 40%

24 Hernia of Morgagni Antero-medial defect Para-esophageal Lucencies in mediastinum Respiratory distress Surgical correction

25 Eventration of diaphragm

26 Pathology Attenuation of central muscular portion of diaphragm Phrenic nerve damage Idiopathic ( birth injury )

27 Clinical presentation Similar to CDH Respiratory birth Recurrent respiratory tract infections in infancy

28 Chest X - Ray Elevated thinned out diaphragm Bowel loops in chest Mediastinal shift

29 Chest X - Ray

30 Treatment Surgical repair of the defect Abdominal approach


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