experimental diaphragmatic hernia and tracheal ligtion in ... · = abstract = experimental...

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= Abstract = Experimental Diaphragmatic Hernia and Tracheal Ligtion in a Fetal Rabbit Model Ma-Hae Cho, MD., Woo-Ki Kim*, M.D. Depa rtment of General Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine & Department of General Sur gery, Seoul National University College of Medicin &, Seoul, Korea Despite of advances in perinatal management and treatment modalities conge- nital diaphragmatic hernia(CDH) remains a frustrating problem. Although the sheep has proven to be a reliable experimental model for the production of in- trauterine CDH, the rabbit may have some advantages. These include lower cost, smaller body size, year-round availability, high number of fetuses per pregnancy, and short gestational period. To evaluate the feasibility of the rabbit model of CDH, twenty-seven pregnant New Zealand rabbits were utilized. Hysterotomy and an operative procedure for creating a diaphragmatic defect on gestational day 24 or 25 , in two fetuses of each pregnant rabbit were performed. In one fetus of one cornu of the uterus, the left fetal diaphragm was excised through an open thoracotomy(DH group). In another fetus in the other cornu, CDH was created and the trachea clipped(Surgiclip, USSC, Norwalk, Conn ., USA) (TL group). Delivery was by Cesarean section on 30 days of gestation. Among twenty- seven pregnant rabbits, 12 in the DH group and eight in the TL group were born alive. The most common herniated organ was the left lobe of the liver. In thee DH group, the lungs were hypoplastic with decreased lung weightlbody weight ratio, reduced numbers of alveoli, thicker media of the pulmonary arteries, and immature alveoli. In TL group, the alveoli were more mature and did not differ from the control animals. In conclusion, (1) pulmonary hypoplasia develops in the fetal rabbit diaphragmatic hernia model and (2) simultaneous tracheal ligation prevents pulmonary hypoplasia. Index Words: Diaphra{{matic hernia, Fetal sur{{ery, Tracheal li{{ation, Animal model Correspondence : Ma-Hae Cho, Department of General Surgery, Hallym Sacred Heart Hospital, Hallym Univer- sity College of Medicine, #896 Pyungchon-Dong, Dongan- Gu, Anyang-City, Kyunggi-Do 431-070, Korea - 1 -

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Page 1: Experimental Diaphragmatic Hernia and Tracheal Ligtion in ... · = Abstract = Experimental Diaphragmatic Hernia and Tracheal Ligtion in a Fetal Rabbit Model Ma-Hae Cho, MD., Woo-Ki

= Abstract =

Experimental Diaphragmatic Hernia and Tracheal Ligtion in a Fetal

Rabbit Model

Ma-Hae Cho, MD., Woo-Ki Kim*, M.D.

Department of General Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine & Department of General Surgery, Seoul National University College of Medicin&,

Seoul, Korea

Despite of advances in perinatal management and treatment modalities conge­nital diaphragmatic hernia(CDH) remains a frustrating problem. Although the sheep has proven to be a reliable experimental model for the production of in­trauterine CDH, the rabbit may have some advantages. These include lower cost, smaller body size, year-round availability, high number of fetuses per pregnancy, and short gestational period. To evaluate the feasibility of the rabbit model of CDH, twenty-seven pregnant New Zealand rabbits were utilized. Hysterotomy and an operative procedure for creating a diaphragmatic defect on gestational day 24 or 25, in two fetuses of each pregnant rabbit were performed. In one fetus of one cornu of the uterus, the left fetal diaphragm was excised through an open thoracotomy(DH group). In another fetus in the other cornu, CDH was created and the trachea clipped(Surgiclip, USSC, Norwalk, Conn., USA) (TL group). Delivery was by Cesarean section on 30 days of gestation. Among twenty- seven pregnant rabbits, 12 in the DH group and eight in the TL group were born alive. The most common herniated organ was the left lobe of the liver. In thee DH group, the lungs were hypoplastic with decreased lung weightlbody weight ratio, reduced numbers of alveoli, thicker media of the pulmonary arteries, and immature alveoli. In TL group, the alveoli were more mature and did not differ from the control animals. In conclusion, (1) pulmonary hypoplasia develops in the fetal rabbit diaphragmatic hernia model and (2) simultaneous tracheal ligation prevents pulmonary hypoplasia.

Index Words: Diaphra{{matic hernia, Fetal sur{{ery, Tracheal li{{ation, Animal model

Correspondence : Ma-Hae Cho, Department of General

Surgery, Hallym Sacred Heart Hospital, Hallym Univer­

sity College of Medicine, #896 Pyungchon-Dong, Dongan-

Gu, Anyang-City, Kyunggi-Do 431-070, Korea

- 1 -

Page 2: Experimental Diaphragmatic Hernia and Tracheal Ligtion in ... · = Abstract = Experimental Diaphragmatic Hernia and Tracheal Ligtion in a Fetal Rabbit Model Ma-Hae Cho, MD., Woo-Ki

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Table 1. Herniated Abdominal Organs in Rabbit

Herniated organ DH*

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Fig. 1. Photographs at autopy in diaphragmatic hernia rabbit. (A) DR rabbit; chest open via median sterno­tomy. Stomach and small bowel are herniated. Lung and heart are removed. (B) TL rabbit; chest open via median sternotomy. Stomach and liver are herniated. Metal clip (arrow) is seen at the proximal part of the trachea (DR ; diaphagmatic hernia, TL, tracheal ligation).

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Page 3: Experimental Diaphragmatic Hernia and Tracheal Ligtion in ... · = Abstract = Experimental Diaphragmatic Hernia and Tracheal Ligtion in a Fetal Rabbit Model Ma-Hae Cho, MD., Woo-Ki

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Fig. 2. Gross appearance of the lung. Control Rabbit (A), DH Rabbit (B) and TL Rabbit (C).

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Page 4: Experimental Diaphragmatic Hernia and Tracheal Ligtion in ... · = Abstract = Experimental Diaphragmatic Hernia and Tracheal Ligtion in a Fetal Rabbit Model Ma-Hae Cho, MD., Woo-Ki

Fig. 4. Photomicrographs of random fields of the lung. (A) Control newborn rabbit lung. Note the thin alveolar septa and minimal amount of interstitial tissue (H & E, X 2(0). (B) DH rabbit lung. When compared with (A), alveolar walls are markedly thickened, interstitial tissue is increased, and alveolar air space is diminished (H & E, X 2(0). (C) TL rabbit lung. Alveolar septa, interstitial tissue, and alveolar air space have returned to normal (H & E, X 2(0).

Fig. 5. Photomicrographs of pulmonary arterial vessels. (A) Pulmonary artery(ED*<O.l mm) in control newborn rabbit (H & E, x 4(0). (B) Pulmonary artery (ED<O.l mm) in rabbit with DH. The arterial wall is significantly increased in thickness (H & E, x 400). (C) Pulmonary artery (ED<O.l mm) in rabbit with TL. The arterial wall thickness is not significantly different from control rabbit lung (H & E, x 400). ED*: External diameter

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Page 5: Experimental Diaphragmatic Hernia and Tracheal Ligtion in ... · = Abstract = Experimental Diaphragmatic Hernia and Tracheal Ligtion in a Fetal Rabbit Model Ma-Hae Cho, MD., Woo-Ki

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Page 7: Experimental Diaphragmatic Hernia and Tracheal Ligtion in ... · = Abstract = Experimental Diaphragmatic Hernia and Tracheal Ligtion in a Fetal Rabbit Model Ma-Hae Cho, MD., Woo-Ki

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Page 8: Experimental Diaphragmatic Hernia and Tracheal Ligtion in ... · = Abstract = Experimental Diaphragmatic Hernia and Tracheal Ligtion in a Fetal Rabbit Model Ma-Hae Cho, MD., Woo-Ki

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~ 9 --

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