Journal of Pediatric Surgery
Volume 31, Issue 4 , Pages 507-511, April 1996

Surfactant decreases pulmonary vascular resistance and increases pulmonary blood flow in the fetal lamb model of congenital diaphragmatic hernia

  • Stuart J. O'Toole

      Affiliations

    • Buffalo Institute of Fetal Therapy (BIFT), The Children's Hospital of Buffalo, Buffalo, NY, USA.
    • the Department of Surgery, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • the Department of Pediatrics, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
    • the Department of Obstetric and Gynecology, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • ,
  • Hratch L. Karamanoukian

      Affiliations

    • Buffalo Institute of Fetal Therapy (BIFT), The Children's Hospital of Buffalo, Buffalo, NY, USA.
    • the Department of Surgery, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • the Department of Pediatrics, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
    • the Department of Obstetric and Gynecology, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • ,
  • Frederick C. Morin III

      Affiliations

    • Buffalo Institute of Fetal Therapy (BIFT), The Children's Hospital of Buffalo, Buffalo, NY, USA.
    • the Department of Surgery, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • the Department of Pediatrics, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
    • the Department of Obstetric and Gynecology, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • ,
  • Bruce A. Holm

      Affiliations

    • Buffalo Institute of Fetal Therapy (BIFT), The Children's Hospital of Buffalo, Buffalo, NY, USA.
    • the Department of Surgery, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • the Department of Pediatrics, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
    • the Department of Obstetric and Gynecology, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • ,
  • Edmond A. Egan

      Affiliations

    • Buffalo Institute of Fetal Therapy (BIFT), The Children's Hospital of Buffalo, Buffalo, NY, USA.
    • the Department of Surgery, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • the Department of Pediatrics, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
    • the Department of Obstetric and Gynecology, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • ,
  • Richard G. Azizkhan

      Affiliations

    • Buffalo Institute of Fetal Therapy (BIFT), The Children's Hospital of Buffalo, Buffalo, NY, USA.
    • the Department of Surgery, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • the Department of Pediatrics, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
    • the Department of Obstetric and Gynecology, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • ,
  • Philip L. Glick

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Philip L. Glick, MD, The Buffalo Institute of Fetal Therapy, Department of Pediatric Surgery, The Children's Hospital of Buffalo, 219 Bryant St, Buffalo, NY 14222.
    • Buffalo Institute of Fetal Therapy (BIFT), The Children's Hospital of Buffalo, Buffalo, NY, USA.
    • the Department of Surgery, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.
    • the Department of Pediatrics, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
    • the Department of Obstetric and Gynecology, State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, NY, USA.

Abstract 

Introduction: Experiments using animal models of neonatal respiratory distress syndrome have shown a decrease in pulmonary vascular resistance (PVR) with surfactant replacement, whereas studies with the lamb model of congenital diaphragmatic hernia (CDH) have demonstrated improvement in oxygenation and lung mechanics with this therapy. The aim of the present study was to measure the effects of surfactant replacement therapy on the pulmonary hemodynamics of the lamb model of CDH.Methods: Ten lambs with surgically created CDH and five control lambs were instrumented at term, with the placental circulation intact. Ultrasonic flow probes were positioned around the main pulmonary artery and the common origin of the left and right pulmonary arteries to record total lung and main pulmonary artery blood flow. Catheters were inserted to record systemic, pulmonary, and left atrial pressure. Five CDH animals received 50 mg/kg of surfactant by tracheal instillation just before delivery. All 15 animals were then ventilated for 4 hours.Results: Correcting the surfactant deficiency in the CDH lamb resulted in a significant increase in pulmonary blood flow, a decrease in PVR, and a reduction in right-to-left shunting. These improvements in hemodynamics were associated with a significant improvement in gas exchange over 4 hours.Conclusion: The fetal lamb model of CDH has elevated PVR in comparison to controls. Prophylactic surfactant therapy reduces this resistance and dramatically increases pulmonary blood flow while reducing extrapulmonary shunt. A surfactant deficiency may be partially responsible for the persistent pulmonary hypertension in neonates with CDH.

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 Presented at the 42nd Annual International Congress of the British Association of Paediatric Surgeons, Sheffield, England, July 25–28, 1995.

 Supported in part by grants from the American Lung Association, the Women and Children's Health Research Foundation, National Institute of Health grant (HHL 49977, HL 36543), and the U.S. Surgical Corporation, Norwalk, CT.

PII: S0022-3468(96)90484-4

Journal of Pediatric Surgery
Volume 31, Issue 4 , Pages 507-511, April 1996

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