SummaryWe report a case in which the trachea of a 3-week-old infant with a double aortic arch and secondary tracheomalacia was intubated for nearly 10 months prior to tracheal surgery. Postoperatively no complications relating to surgery or intubation were seen.
Accepted 21 January 1983 occasionally. Several authors have noted that neonates who survive operation often improve dramatically at first but subsequently deteriorate with increasing hypoxaemia and die.3 4 1 The initial improvement indicates that pulmonary hypoplasia is probably not the primary cause of death. An increase in pulmonary vascular resistance and shunting of blood away from the lungs through a persisting "fetal" circulation have been shown in these patients" and may be the mechanism leading to clinical deterioration with increasing hypoxaemia.Infants with a congenital diaphragmatic hernia requiring operation within 24 hours of birth are usually considerably hypoxic and acidotic at the time of diagnosis. Hypoxia and acidosis both cause pulmonary vasoconstriction'2-4 and thus favour the persistence of a fetal-type circulation with right-to-left shunting. It has been shown in adults'3 and in newborn calves'4 that if the hydrogen-ion concentration of the blood is maintained at near-normal values3 '5 hypoxia produces only minor changes in the pulmonary vasculature, whereas it causes appreciable pulmonary vasoconstriction in the presence of acidosis. This research suggests that a disastrous condition may be prevented if the acid-base balance is carefully controlled in affected infants.Hypoxia and acidosis also cause myocardial depression and peripheral vasoconstriction, which 254 on 11 May 2018 by guest. Protected by copyright.
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