title: Thoraco-abdominal asymmetry and asynchrony in congenital diaphragmatic hernia.
abstract: OBJECTIVE
  Congenital diaphragmatic hernia (CDH) consists of an incomplete formation of the diaphragm and the subsequent herniation of abdominal bowels. Diaphragmatic defect can be repaired by primary closure or placing a patch. Respiratory follow up usually focuses on spirometric and clinical evaluation. The aim of the study was to assess thoraco-abdominal volumes in CDH patients and to verify whether the action of the diaphragm on the chest wall is altered leading to an asymmetric and asynchronous expansion of the different thoracoabdominal compartments.
  
  
  METHODS
  Total and compartmental chest wall volumes and asynchronies were measured by Opto-Electronic Plethysmography in 14 CDH patients (7 M/7F, age 5 ± 2 years, 12 left side operated) and in 9 age matched healthy subjects during quiet spontaneous breathing in supine position. Patients were divided in two groups: five patients with suture (group S) and nine patients with diaphragmatic patch (group P). Pulmonary function was assessed by spirometry and spirometric parameters were expressed as Z-score.
  
  
  RESULTS
  In group P abdominal contribution to tidal volume was lower than healthy controls and group S. Unlike controls, in both CDH groups the right side of pulmonary rib cage moved inward with a correspondent left side expansion during inspiration. In group S, thoraco-abdominal asynchronies were higher than in group P and controls, especially in the right side. Five patients belonging to group P had a spirometric obstructive pattern.
  
  
  CONCLUSIONS
  In overall CDH patients a reduced action of the treated (left) hemi-diaphragm is evident. In patients treated by primary suture, a compensatory action of the right side allows to reach a normal total diaphragmatic displacement and a proper contribution of the whole diaphragm to tidal volume. In patients treated by diaphragmatic patch, instead, thoraco-abdominal asynchronies are prevented.
authors: Dipartimentodi Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy.
authors: Marianna
authors: M
authors: Laviola
authors: Chirurgia Pediatrica, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy.
authors: Andrea
authors: A
authors: Zanini
authors: Dipartimentodi Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy.
authors: Rita
authors: R
authors: Priori
authors: Chirurgia Pediatrica, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy.
authors: Francesco
authors: F
authors: Macchini
authors: Chirurgia Pediatrica, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy.
authors: Ernesto
authors: E
authors: Leva
authors: Chirurgia Pediatrica, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy.
authors: Maurizio
authors: M
authors: Torricelli
authors: Clinica De Marchi, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Milano, Milano, Italy.
authors: Clara
authors: C
authors: Ceruti
authors: Dipartimentodi Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy.
authors: Andrea
authors: A
authors: Aliverti
mesh_terms: D000005:Abdomen / Q000503:physiopathology*; D000222:Adaptation, Physiological; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D010991:Plethysmography; D012119:Respiration; D013147:Spirometry; D035441:Thoracic Wall / Q000503:physiopathology*
keywords: airway muscle; congenital diaphragmatic hernia; congenital malformations; respiratory