Am. J. Respir. Crit. Care Med., Volume 157, Number 3, March 1998, 921-927

Lung Growth and Maturation after Tracheal Occlusion in Diaphragmatic Hernia

ALEXANDRA BENACHI, BERNADETTE CHAILLEY-HEU, ANNE-LISE DELEZOIDE, MARC DOMMERGUES, FRANCIS BRUNELLE, YVES DUMEZ, and JACQUES R. BOURBON

Unité de Médecine Foetale, Hôpital Port-Royal-Baudelocque, Paris; INSERM U 319, Université Paris 7, Paris; Service d'Histologie-Embryologie and Service de Radiologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France

Tracheal occlusion (TO) was performed at 120 d of gestation by noninvasive endoscopic technique using a releasable latex balloon, in fetal lambs with diaphragmatic hernia (DH) established at 85 d. The lungs were studied at 139 d in five fetuses with DH + TO, five fetuses with DH only, and six control fetuses. Fluid retention consecutive to TO allowed fetal lungs to grow. Histological pulmonary structure was more mature in DH + TO than in DH alone. The growth-inducing effect of TO was however incomplete, with an increased protein/DNA ratio. Tissue phospholipids were increased, but this was not reflected in the surfactant compartment. The major surfactant component, disaturated phosphatidylcholine, was reduced to 58% of its control value in DH, and further reduced to 17.5% of its control value in DH + TO. The proportion of surfactant protein B immunoreactive cells, assumed to represent the proportion of type II cells, was increased in DH (27% of all parenchymal cells), and reduced in DH + TO (7.8%) as compared with control fetuses (15%). In conclusion, although noninvasive tracheal occlusion in utero is feasible and may partly compensate the adverse effects of DH on lung organogenesis, it reduces the number of type II cells and induces a dramatic surfactant deficit. Using this technique in human fetuses requires careful consideration until further evaluation of lung functional characteristics has been achieved in this experimental model.

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