title: Postoperative regional distribution of pulmonary ventilation and perfusion in infants with congenital diaphragmatic hernia.
abstract: OBJECTIVE
  Advances in management of patients with congenital diaphragmatic hernia (CDH) have improved mortality rates but with a risk of increased pulmonary morbidity. The prognosis for CDH survivors remains difficult to predict owing to the lack of adequate methods. We used single photon emission computed tomography (SPECT) to measure the regional distribution of ventilation and perfusion in CDH infants to quantify the degree of lung function impairment and relate it to neonatal clinical disease severity.
  
  
  METHODS
  Single photon emission computed tomography was performed in 12 CDH infants at the mean age of six months. Ventilation and perfusion were traced with 5 MBq Technegas and technetium-labelled albumin macro-aggregates, respectively. Neonatal clinical data collected during the patient's stay in the pediatric intensive care unit was correlated with the SPECT data.
  
  
  RESULTS
  Single photon emission computed tomography revealed varying degrees of ventilation-perfusion abnormalities which correlated with the presence of pulmonary artery hypertension, days on ventilator and days on extracorporeal membrane oxygenation.
  
  
  CONCLUSIONS
  The grade of clinical disease severity in infants following CDH repair is closely related to the ventilation-perfusion abnormality as seen using SPECT. The persistence of pulmonary artery hypertension into the postoperative neonatal period appears to be an important pathophysiological factor related to ventilation-perfusion abnormalities. Single photon emission computed tomography provides valuable clinical information for patient follow-up.
authors.affiliation: Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden. Karin.Bjorkman@karolinska.se
authors.forename: Karin C
authors.initials: KC
authors.lastname: Björkman
authors.forename: Malin
authors.initials: M
authors.lastname: Kjellberg
authors.forename: Sten Erik
authors.initials: SE
authors.lastname: Bergström
authors.forename: Baldvin
authors.initials: B
authors.lastname: Jonsson
authors.forename: Sten
authors.initials: S
authors.lastname: Lindahl
authors.forename: Peter
authors.initials: P
authors.lastname: Radell
authors.forename: Malin
authors.initials: M
authors.lastname: Rohdin
authors.forename: Alejandro
authors.initials: A
authors.lastname: Sanchez-Crespo
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008168:Lung / Q000000981:diagnostic imaging*; D010102:Oxygen Inhalation Therapy; D012123:Pulmonary Ventilation; D019275:Radiopharmaceuticals; D013670:Sodium Pertechnetate Tc 99m; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon; D014692:Ventilation-Perfusion Ratio
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C056708:Technegas; D013670:Sodium Pertechnetate Tc 99m