CDH

Question 1

Embryonic Development of CDH

Answer 1

Incompletely understood and complex. Development of diaphragm starts between week 3-5 week of gestation and by the 8th week of gestation resulted in disruption in the process in the separation of pleural and abdominal cavities via closure of pleuroperitoneal canal.

Question 2

What is Bochdalek henia?

Answer 2

Posterolateral CDH hernia

Question 3

Frequency (in %) of Bochdalek hernia?

Answer 3

90%

Question 4

What is Morgagni Henia?

Answer 4

CDH hernia via anteriorly

Question 5

Frequency (in %) of Morgagnihernia?

Answer 5

10%

Question 6

How is fetal lung affected by CDH?

Answer 6

Herniation of visceral contents into the thoracic cavity leads to pulmonary hypoplasia bilaterally with greater impact on the ipsilateral side. Underdeveloped lungs have decreased bronchiole branching, bronchioles, and alveoli with limited capability for gas exchange.

Question 7

How is pulmonary vasculature affected by CDH?

Answer 7

Decrease pulmonary vasculature, hyper-muscular arteries, increased pulmonary vascular resistance

Question 8

Prenatal diagnosis of CDH

Answer 8

Via ultrasound. Polyhydramnios; prescence of stomach, liver, or bowel loops seen within the thoracic cavity; and/or mediastinal shift are hallmark findings consistent with CDH.

Question 9

How to best estimate the severity of CDH?

Answer 9

LHR, O/E LHR

Question 10

What is LHR

Answer 10

Lung to head ratio. Ratio of contralateral lung to the head circimufrence

Question 11

What is O/E LHR and how is it different from LHR?

Answer 11

Takes into consideration of gestational age to predict prognosis

Question 12

LHR. What value is best for survival and what is associated with poor prognosis?

Answer 12

> 1.5, and <1.0

Question 13

O/E LHR. What value is best for survival and what is associated with poor prognosis?

Answer 13

Less than 25% is associated with less than 30% survival rate