The prognostic factors of congenital diaphragmatic hernia patients and theevaluation of the effects of lung development with ventilation-perfusion scintigraphy

Congenital posterolateral diaphragmatic hernias are the anomalies that the mortality rates are changing between 10%-35% with the latest improvements. The aim of our study is to determine the prognostic factors of survival of congenital diaphragmatic hernia patients and to evaluate the effects of lung development with ventilation-perfusion scintigraphy. There are 55 patients who were operated with the diagnosis of congenital posterolateral diapragmatic hernia between January 2000 and April 2010 in pediatric surgery clinic of Ankara Baskent University Hospital and Adana Research Center were evaluated retrospectively with their demographic findings, probable prognostic factors, surgery results and the results of 19 patients' ventilation-perfusion scintigraphy in the infancy period. The mortality ratio of our congenital diapragmatic hernia patients is 20%. The prognosis was influenced bad with postterms (p=0,013), the right sided congenital diapragmatic hernia patients (p=0,042), patients with diameter of the defect were 4 and more than 4 (p=0,015), the apgar score was less than 5 in the fifth minute (p=0,001), the left sided congenital diapragmatic hernia patients with liver herniation (p=0,018), the patients who had cardiac anomalies (p=0,048), the patients who had pulmonary hypertension (p=0,001), the patients who had low pH values in the first, pre and post operation blood gases (p=0,024, p=0,001, p=0,000) and the high PaCO2 values in the first, pre and post operation (p=0,014, p=0,001, p=0,000). The perfusion and ventilation were decreased in ipsilateral lung and elevated in contalateral lung. The ipsilateral lung ventilation was badly ifluenced in boy patients (p=0,042). The ipsilateral using of patchs were influenced badly the perfusion (p=0,039) and ventilation (p=0,039). The patients who had left sided hernias with gastric herniation had ipsilateral low lung perfusion (p=0,014) and contralateral high lung perfusion (p=0,014) and the patients who had liver herniation had contralateral high lung ventilation (p=0,013) were also demonstrated with the evalution of ventilation-perfusion scintigraphy The ventilation-perfusion scintigraphy could be done infants very easly and could demonstrate the affected breath functions because of the pulmonary hypoplasia. Boy gender, using patchs, left sided hernias with gastric and liver herniation were contributed pulmonary hypoplasia in living patients.