title: Pulmonary artery size as an indication for thoracoscopic repair of congenital diaphragmatic hernia in neonates.
abstract: OBJECTIVE
  We reviewed 24 consecutive cases of prenatally or immediately postnatally diagnosed left-sided congenital diaphragmatic hernia (CDH) to evaluate pulmonary artery (PA) size as an indication for thoracoscopic repair (TR).
  
  
  METHODS
  CDH repair is planned once echocardiography confirms improvement in pulmonary hypertension. TR is chosen if cardiopulmonary status is stable more than 10 min in the decubitus position in the neonatal intensive care unit (NICU) under conventional mechanical or high frequency oscillatory ventilation (HFOV) with/without nitric oxide (NO) and the patient appears likely to tolerate manual ventilation during transfer to the operating room. Otherwise open repair (OR) is performed in NICU. Proximal right PA (RPA) and left PA (LPA) diameters measured at birth were assessed with respect to the type of repair.
  
  
  RESULTS
  10/24 had TR and 14/24 had OR. TR cases had significantly larger RPA/LPA diameters (3.52 ± 0.23 vs. 3.10 ± 0.56 mm, p < 0.05 for RPA; 3.04 ± 0.26 vs. 2.48 ± 0.37, p < 0.01 for LPA), and significantly less requirement for HFOV (70 vs. 100 %, p < 0.05) and NO (20 vs. 86 %, p < 0.01). Four TR required conversion to OR for technical reasons (n = 3) and cardiopulmonary instability (n = 1).
  
  
  CONCLUSIONS
  TR can be considered when RPA/LPA diameters are larger than 3.0/2.5 mm, respectively, and cardiopulmonary status is stable without NO.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan. okazakit@juntendo.ac.jp
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Kinya
authors.initials: K
authors.lastname: Nishimura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Shoji
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Shintaro
authors.initials: S
authors.lastname: Makino
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeda
authors.forename: Eiichi
authors.initials: E
authors.lastname: Inada
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D057234:Preoperative Period; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*