Diaphragmatic hernia (hernia or diaphragmatic CDH - Congenital diaphragmatic hernia)

The Perinatal Center of the Danube Hospital specializes in this malformation. Congenital defects of the diaphragm are referred to as so-called diaphragmatic hernia. They are located at "weak points" of the diaphragm, namely in lumbocostalen and sternocostalen area.
A distinction is thus the following two types of hernias:
Types of congenital diaphragmatic hernia seen from the abdomen of
Types of congenital diaphragmatic hernia seen from the abdominal cavity. The blue box corresponds to the point of penetration of the vena cava, the yellow box of the esophagus and the red of the aorta.


    The sternocostale hernia (Morgagni hernia so-called):
    It is usually small and located just next to the sternum on the front wall of the chest. They can extend through portions of the liver (hump) in the chest. Often the hernia is asymptomatic and is diagnosed as an incidental finding. The surgical correction consists of a diaphragm seal the gap medium seam. The "liver hump" is shifted into the abdominal cavity and diminishes over time.
    
    The lumbocostale hernia (CDH):
    It is of various sizes and can be found on the exterior rear wall of the chest. The typical form is in the form of a gap, so that organs in the abdominal cavity slide (stomach, spleen, small intestine and colon, left. Portion of the liver) in the chest, hampering growth as the lungs. The mediastinum (mediastinal) is re-click the. Side down. The gap is greater than that of the sternocostalen hernia.

The big problem of the typical diaphragmatic hernia is that the lungs do not develop sufficiently. I.e. the bronchial tree is small, the number of alveoli is lower, the number of pulmonary arteries is low, the vessels are thick-walled (muscles) and an increased sensitivity with spasms (vascular spasms). The underdeveloped lungs can flow through the blood decreased only have problems with the blood of enough oxygen to accumulate and thus supply the body after birth is sufficient. Critical are the "big" hernias, where portions of the liver are present in the chest.

In any case, a baby with a diaphragmatic hernia in a neonatal unit (obstetrics, neonatology, pediatric intensive care medicine, Child and Adolescent Surgery) brought to the world. It may be necessary for the child to be artificially ventilated immediately after birth. The ventilation strategies, which should include helping the small lungs, for example, the high-frequency ventilation (special ventilator) and the NO - admixture to reduce pulmonary vascular resistance. In rare and severe cases, we perform in a so-called Danube Hospital ECMO (extracorporeal membrane oxygenation) by complementary therapy. Here are the lungs and heart of a "machine" for some time taken (to about 1 week). Once the child is medically stabilized after delivery (24 - 48h, drop in blood pressure in the pulmonary circulation; suspend the persistent fetal circulation "PFC") has carried out the pediatric surgical closure of the diaphragmatic defect. This must be done at times as so-called diaphragm plastic with an artificial material (patch).
Temporary (1 week) ECMO therapy
Temporary (1 week) ECMO therapy (OA Dr. Ch disc plow; christian.scheibenpflug @ wienkav.at) with a baby in the Danube Hospital, taking support of the circulation and lung function of a "machine" incorporated. The "small lung" can grow and heal. Even at this highest level of intensive care, parents should as often as possible have the opportunity to be with her child!

An alternative to surgical treatment of the child after birth, treatment in the womb before birth. Here, between the 24th and 26 Weeks of gestation, the trachea of ??a child (this is not required) endoscopically over a period of 2 weeks sealed with a balloon. In the airways, rises through the secretion of the pressure in the lung fluid at 2 mm Hg. This minimal increase in pressure is sufficient that the lungs increase in size and the institutions that have happened in the chest a little push back into the abdominal cavity. This therapy should be discussed, especially in those cases that have a poor prognosis (left portion of the liver also in the chest; unfavorable head: lungs - ratio (Lung Head Ratio) at 1 - from 1.4 significantly better opportunities; polyhydramnios - ie much too much amniotic fluid). In the Danube Hospital is jan.deprest for these complicated cases, an international collaboration with Prof. Dr. Jan Deprest (gynecology and obstetrics / fetal surgery TO Gasthuisberg Herestraat 49 B-3000 Leuven zu.kuleuven.ac.be @, or eurofoetus@eurofoetus.org )

Basic procedure in prenatally diagnosed
Diaphragmatic hernia:

    Confirmation from several ultrasound examinations
    Contact with a perinatal center
    Supplement the diagnosis by magnetic resonance imaging (MRI)
    Determining the size of the defect, the lungs and the exclusion of additional malformations.
    Meeting with the gynecologist and the pediatric surgeon and determine further procedure. You may consider an intrauterine Trachealokklusion (Balloon closure for 14 days).
    Delivery of an experienced perinatal (stage IV) in the presence of neonatologists and pediatric surgeons.