Primary Combined Latissimus Dorsi and Serratus Anterior Flap Repair of Right-Sided Congenital Diaphragmatic Agenesis in a Neonate

Samuel, Madan; Parapurath, Rajiv

doi:10.18295/squmj.2016.16.01.018

Cited by 3 publications

(13 citation statements)

References 16 publications

(22 reference statements)

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“…However, Sheehan et al believe that these cases were actually large CDHs as mesh repair was performed using remnant of the diaphragm in two of them [3].The incidence of congenital diaphragmatic agenesis (CDA) is one in 250,000 births. In contrast, the frequency of CDH is one in 2,200-2,450 births [4]. The incidence of CDA is reportedly 27-31% of cases of CDH.…”

Section: Discussionmentioning

confidence: 94%

“…Since we had no alternative, we elected to repair the lesion by a mesh despite the previously reported high complication rate associated with this type of repair [2]. The drawbacks of a synthetic mesh repair include recurrence of the defect, patch dislodgement or infection, progressive chest wall deformities and restrictive pulmonary function [4]. On the other hand, some consider an elective repair of AHD by a prosthetic mesh an optimum option [3].…”

Section: Discussionmentioning

confidence: 99%

“…Samuel and Parapurath reported the first successful primary repair of a complete CDA in a neonate using flaps of latissimus dorsi and serratus anterior muscles reinforced by a flexible composite mesh. The authors believe that their technique provides the patients with an intact compliant functional muscular structure [4]. We wonder if the results of this repair technique of CDA in neonates are similarly applicable to adult patients.…”

Section: Discussionmentioning

confidence: 99%

“…Agenesis of the hemi-diaphragm (AHD) refers to the complete absence of the hemidiaphragm on one or both sides. Such congenital anomaly is thought to result from the failure of the pleuro-peritoneal membrane to close the pleuroperitoneal canal or the failure of the development of all four precursor components of the developing diaphragm [2][3][4]. Bilateral AHD is very rare [5] and infants with this defect rarely survive to have surgical intervention [6].…”

Section: Introductionmentioning

confidence: 99%

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Complete agenesis of the right hemi-diaphragm in an adult: case report and literature review.

Taha

Kaznazani²

2021

JFacMedBagdad

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Congenital agenesis of the hemi-diaphragm (AHD) in adults is rare and exceedingly so on the right side. Since its first recognition in 1959, no more than 9 cases have been published in the English literature by the year 2016. “Partial diaphragm agenesis” is actually large congenital diaphragmatic hernia (CDH) rather than true AHD. Respiratory compromise is the likely presentation, however, patients may survive for years without symptoms. Despite a straightforward clinical and radiographic diagnosis of AHD, the best method of repair is controversial. Herein, we present a case of complete right-sided AHD in a man of 54 diagnosed on surgical exploration 16 years earlier. Despite trans-thoracic mesh repair, the patient experienced just a modest improvement of his shortness of breath (SOB). Though the liver persisted high in the chest as shown by serial CT scans of the chest, polypropylene mesh was effective in preventing further visceral herniation. Adult patients with right-sided AHD always deserve operative intervention to avoid the potential complications.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Complete agenesis of the right hemi-diaphragm in an adult: case report and literature review.

Taha

Kaznazani²

2021

JFacMedBagdad

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“…At the same time, experts' recommendations state that timely and adequate preoperative preparation and radical surgical treatment of newborns with AD can save their lives [5,7,20,21]. Valente A, Brereton RJ (1987) noted that the survival rate among 37 treated children with diaphragmatic hernias over 4.5 years was 68%, while in the group of children with AD this number was even lower: only 4 out of 10 treated patients survived [20].…”

Section: Discussionmentioning

confidence: 99%

Agenesis of the Diaphragm: A Case Report and a Brief Literature Review

TURAKULOV¹,

BARATOV²

2022

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Objective: Agenesis of the diaphragm (AD) in adults is an extremely rare congenital malformation. To date, only a few descriptions of this pathology have been published in the scientific literature. The article presents a case of detection of a left-sided AD in a 25-year-old patient operated on for diaphragmatic relaxation. Additional examination methods, including echocardiography and ultrasonography of the abdominal organs and retroperitoneal space, did not reveal any other malformations in this patient. Due to the lack of plastic material of the appropriate size and type, plastic replacement of the diaphragm was postponed to the second stage of surgery. Keywords: Congenital malformations, anomalies of the diaphragm, aplasia of the diaphragm, agenesis of the diaphragm, agenesis of the diaphragm in adults, diaphragmatic hernia, plastic surgery of the diaphragm.

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Neurological Outcome in Children Post–Sildenafil Therapy for Persistent Pulmonary Hypertension of the Newborn

Parapurath,

2023

Preprint

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Purpose: Evaluation of neurological outcome post sildenafil and inhaled nitric oxide (iNO) therapy in the first 72-months of life. Material and Methods: Prospective linear study of 84-neonates with severe persistent pulmonary hypertension of the newborn (PPHN). All neonates were on high frequency oscillatory ventilation (HFOV), surfactant, and inotropic support. In 40-neonates iNO was utilized, and intragastric sildenafil in 44-newborns. Bayley IIIUK was used at 38-months of age for developmental assessment. Intellectual ability was evaluated at 72-months of age by Wechsler Intelligence Scale for Children-Fourth EditionUK. Results: iNO monotherapy had a mortality rate of 4% versus 0% on sildenafil, p = 0.001. Resolution of PPHN without sequelae occurred in 81%, iNO 68% versus 93% sildenafil, p = 0.0001. Resolution with neurological impairment ensued in 19%, iNO 32% versus 7% on sildenafil, p = 0.0001. Resolution with chronic lung disease was observed in 5%, iNO 8% versus 2% sildenafil, p = 0.020. Intragastric sildenafil monotherapy failure rate was 14%. Sildenafil was the predominant variable that reduced mortality, p = 0.02, CI: 0.010 – 0.080. At 38-months, Bayley IIIUK scores were normal ≥85 in 81%. Neurologically normal children at 72-months of age scored either average or high average, qualitatively, on the Wechsler Intelligence Scale for Children-Fourth EditionUK. Effect of sildenafil in the neonatal period was global leading to preserved intellectual, cognitive, and neurological outcome, in later childhood. Conclusions: Intragastric sildenafil can be safely and effectively used in neonates with severe PPHN on HFOV and exogenous surfactant. Effect of sildenafil on neurodevelopment was positive.

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Primary Combined Latissimus Dorsi and Serratus Anterior Flap Repair of Right-Sided Congenital Diaphragmatic Agenesis in a Neonate

Cited by 3 publications

References 16 publications

Complete agenesis of the right hemi-diaphragm in an adult: case report and literature review.

Complete agenesis of the right hemi-diaphragm in an adult: case report and literature review.

Agenesis of the Diaphragm: A Case Report and a Brief Literature Review

Neurological Outcome in Children Post–Sildenafil Therapy for Persistent Pulmonary Hypertension of the Newborn

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