Our Summary

This study aimed to investigate how blood flow in the brain is affected in children who have had surgery to fix a congenital diaphragmatic hernia (CDH), a birth defect where there is an opening in the diaphragm. Some of these children also had a blockage in a major artery in the neck (rCCA) following treatment with a life support machine (ECMO).

The researchers used a type of brain scan to measure blood flow in different parts of the brain in 29 two-year-old children who had undergone surgery to fix CDH. In 14 of these children, the major neck artery was blocked following ECMO therapy. The other 15 children, who had CDH but did not have ECMO therapy, served as a comparison group.

The results showed that in the children with the blocked artery, there were differences in blood flow between the two sides of the brain. Blood flow was significantly lower in the outer and inner layers of the right side of the brain. In one-third of these children, blood flow in the right side of the brain was more than 20% lower than the left side. However, when comparing the average blood flow in children with the blocked artery to the comparison group, there was no difference.

In conclusion, despite differences in blood flow within the brain in children with a blocked artery, the overall blood flow in the right side of the brain is adequate. This is likely due to other blood vessels compensating for the blocked artery.

FAQs

  1. What is the aim of the study on congenital diaphragmatic hernia repair?
  2. What were the findings on cerebral perfusion after repair of congenital diaphragmatic hernia and right-common-carotid-artery occlusion?
  3. What is the significance of the right-common-carotid-artery occlusion in patients after ECMO therapy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to closely monitor cerebral perfusion, especially if the patient has undergone ECMO therapy and right-common-carotid-artery occlusion. Regular imaging studies, such as cerebral magnetic resonance perfusion imaging, can help assess blood flow to the brain and detect any potential issues early on. It is important to follow up with your healthcare provider regularly to ensure proper monitoring and management of any potential complications.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) who have undergone repair surgery are typically recommended for cerebral perfusion evaluation, especially if they have undergone extracorporeal membrane oxygenation (ECMO) therapy and right-common-carotid-artery (rCCA) occlusion. This study specifically looked at 2-year-old children with a history of CDH repair and evaluated their cerebral blood flow using magnetic resonance perfusion imaging. Patients with rCCA occlusion after ECMO therapy showed intra-individual side differences in cerebral perfusion, with lower perfusion in the right hemisphere compared to the left hemisphere. However, overall cerebral perfusion was found to be sufficient after rCCA occlusion due to collateral blood supply. This study highlights the importance of evaluating cerebral perfusion in patients with CDH, especially those who have undergone ECMO therapy and rCCA occlusion.

Timeline

  • Before CDH repair:

  • Patient is diagnosed with congenital diaphragmatic hernia

  • Patient may undergo prenatal testing and monitoring

  • Patient may require respiratory support soon after birth

  • Patient may be placed on ECMO therapy for severe cases

  • After CDH repair:

  • Patient undergoes surgical repair of diaphragmatic hernia

  • Patient may require ECMO therapy post-operatively

  • Patient undergoes follow-up monitoring and imaging studies

  • Patient may experience complications such as right-common-carotid-artery (rCCA) occlusion

  • Patient undergoes cerebral magnetic resonance perfusion imaging to evaluate cerebral perfusion

  • Patients with rCCA occlusion may show intra-individual side differences between hemispheres in terms of cerebral blood flow

  • Overall, patients with rCCA occlusion have sufficient cerebral perfusion due to collateral blood supply.

What to Ask Your Doctor

Some questions a patient with congenital diaphragmatic hernia repair may consider asking their doctor include:

  1. How common is cerebral perfusion impairment after CDH repair and rCCA occlusion?
  2. What are the potential risks or complications associated with rCCA occlusion after ECMO therapy?
  3. How is cerebral perfusion monitored and assessed in patients with CDH and rCCA occlusion?
  4. What are the long-term implications of reduced subcortical perfusion in the right hemisphere?
  5. Are there any specific precautions or interventions that should be taken to optimize cerebral perfusion in patients with rCCA occlusion?
  6. How does collateral blood supply play a role in maintaining overall right hemisphere perfusion after rCCA occlusion?
  7. Are there any additional tests or imaging studies that may be recommended to further evaluate cerebral perfusion in these patients?
  8. What follow-up care or monitoring should be scheduled for patients with CDH and rCCA occlusion to ensure optimal neurological outcomes?
  9. Are there any specific lifestyle modifications or therapies that can help support cerebral perfusion in these patients?
  10. What are the potential implications for future pregnancies or family members in terms of congenital diaphragmatic hernia and cerebral perfusion issues?

Reference

Authors: Henzler C, Zöllner FG, Weis M, Zimmer F, Schoenberg SO, Zahn K, Schaible T, Neff KW. Journal: In Vivo. 2017 Jul-Aug;31(4):557-564. doi: 10.21873/invivo.11094. PMID: 28652420