Short-term tracheal occlusion corrects pulmonary vascular anomalies in the fetal lamb with diaphragmatic hernia

Abstract

Background: Sustained fetal tracheal occlusion (TO) results in accelerated lung growth but causes severe type II cell depletion. Temporary TO fails to cause lung growth in a congenital diaphragmatic hernia (CDH) model but preserves type II cells and corrects pulmonary hypertension. Herein, we study the pulmonary vascular changes caused by temporary TO. Methods: CDH was created in 12 fetal lambs (65-70 d; term, 145 days). In 6 lambs, the trachea was occluded for 2 weeks (CDH + TO; 108-122 d). Animals were killed at 136 days. The lungs were processed with elastin stains and anti-α-smooth muscle actin antibody. Partial or circumferential presence of inner and outer elastic lamina was used to determine muscularization of pulmonary arterioles. The percent of medial wall thickness was plotted against vessel diameter for each group. Results: Lung weight/body weight was smaller in lambs with CDH (1.35% ± 0.56%) and CDH + TO (1.70% ± 0.34%) than in control lambs (3.55% ± 0.56%; P <.05, single-factor analysis of variance). The smallest muscularized vessel was 113 ± 50 μm, and the largest nonmuscularized vessel was 138 ± 49 μm in lambs with CDH, significantly different from control lambs (185 ± 69 μm and 350 ± 116 μm, respectively) and lambs with CDH + TO (185 ± 97 μm and 245 ± 100 μm, respectively; P <.05). In lambs with CDH, only 25% of vessels of less than 60 μm were nonmuscularized, compared with 81% in control lambs (P <.05) and 74% in lambs with CDH + TO. Conclusions. Temporary tracheal occlusion, from 108 to 122 days, corrects the abnormal muscularization of pulmonary arterioles seen in CDH. These morphometric findings parallel physiologic results at birth and further suggest that short-term occlusion, which preserves surfactant-producing type II pneumocytes without lung growth, may be sufficient to improve neonatal outcome of diaphragmatic hernia. (Surgery 2000;128:266-72.)