{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:37:26Z","timestamp":1760236646737,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T00:00:00Z","timestamp":1639008000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000071","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["5R01 HD072929"],"award-info":[{"award-number":["5R01 HD072929"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Children\u2019s Miracle Network at University of California, Davis","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"First Tech Federal Credit Union and UC Davis Pediatrics","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Canadian Pediatric Society NRP research grant","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>The diagnosis of congenital diaphragmatic hernia (CDH) is associated with significant morbidity and mortality. Survival of neonates with CDH has improved recently, although the clinical course is complicated by sequelae of hypoplastic pulmonary parenchyma and vasculature, pulmonary hypertension, ventilation\/perfusion (V\/Q) mismatch, reduced pulmonary function and poor somatic growth. In this case report, we describe an infant with an antenatal diagnosis of CDH with a poor prognosis who underwent initial surgery followed by a tracheostomy but had a worsening clinical course due to a large area of ventilated but poorly perfused lung based on a V\/Q nuclear scintigraphy scan. The emphysematous left lung was causing mediastinal shift and compression of the right lung, further compromising gas exchange. The infant had clinical improvement following bronchial blockade of the under-perfused left lung. This paved the way for further management with resection of the under-perfused lung lobe and continued clinical improvement. We present the novel use of selective bronchial blockade in a challenging case of CDH to determine if surgical lung resection may benefit the infant. We also review the physiology of gas exchange during the use of a bronchial occluder and the relevant literature.<\/jats:p>","DOI":"10.3390\/children8121163","type":"journal-article","created":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T21:52:32Z","timestamp":1639086752000},"page":"1163","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Novel Use of a Bronchial Blocker in a Challenging Case of Congenital Diaphragmatic Hernia\u2014A Case Report"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6704-6949","authenticated-orcid":false,"given":"Deepika","family":"Sankaran","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, University of California at Davis, Davis, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinjiro","family":"Hirose","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Pediatrics, University of California at Davis, Davis, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald","family":"Null","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, University of California at Davis, Davis, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niroop","family":"Ravula","sequence":"additional","affiliation":[{"name":"Division of Pediatric Anesthesiology, Department of Anesthesiology and Pain Medicine, University of California at Davis, Davis, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6098-2155","authenticated-orcid":false,"given":"Satyan","family":"Lakshminrusimha","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, University of California at Davis, Davis, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,9]]},"reference":[{"key":"ref_1","unstructured":"Dumpa, V., and Chandrasekharan, P. (2021). StatPearls, StatPearls Publishing LLC."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40748-017-0045-1","article-title":"Congenital Diaphragmatic hernia\u2014A review","volume":"3","author":"Chandrasekharan","year":"2017","journal-title":"Matern. Health Neonatol. Perinatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.jpeds.2019.09.053","article-title":"Longitudinal Analysis of Ventilation Perfusion Mismatch in Congenital Diaphragmatic Hernia Survivors","volume":"219","author":"Dao","year":"2020","journal-title":"J. Pediatr."},{"key":"ref_4","first-page":"48","article-title":"Single- and double-lung ventilation in infants and children undergoing thoracoscopic lung resection","volume":"23","author":"Dingemann","year":"2013","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1056\/NEJMoa2026983","article-title":"Randomized Trial of Fetal Surgery for Moderate Left Diaphragmatic Hernia","volume":"385","author":"Deprest","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1056\/NEJMoa2027030","article-title":"Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia","volume":"385","author":"Deprest","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jpedsurg.2006.09.018","article-title":"Percent predicted lung volumes as measured on fetal magnetic resonance imaging: A useful biometric parameter for risk stratification in congenital diaphragmatic hernia","volume":"42","author":"Barnewolt","year":"2007","journal-title":"J. Pediatr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1002\/ppul.22557","article-title":"Lung function in young adults with congenital diaphragmatic hernia; a longitudinal evaluation","volume":"48","author":"Spoel","year":"2013","journal-title":"Pediatr. Pulmono."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1007\/s00383-005-1557-8","article-title":"Mid- and long-term effects on pulmonary perfusion, anatomy and diaphragmatic motility in survivors of congenital diaphragmatic hernia","volume":"21","author":"Arena","year":"2005","journal-title":"Pediatr. Surg. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.mri.2017.11.013","article-title":"Histogram based analysis of lung perfusion of children after congenital diaphragmatic hernia repair","volume":"48","author":"Kassner","year":"2018","journal-title":"Magn. Reson. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1002\/uog.7592","article-title":"Lung tissue perfusion in congenital diaphragmatic hernia and association with the lung-to-head ratio and intrapulmonary artery pulsed Doppler","volume":"35","author":"Done","year":"2010","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1159\/000278820","article-title":"Serial perfusion study depicts pulmonary vascular growth in the survivors of non-extracorporeal membrane oxygenation-treated congenital diaphragmatic hernia","volume":"98","author":"Pal","year":"2010","journal-title":"Neonatology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1164\/rccm.201808-1551LE","article-title":"Electrical impedance tomography can identify ventilation and perfusion defects: A neonatal case","volume":"199","author":"Tingay","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1164\/rccm.201607-1370LE","article-title":"Individualized multiplanar electrical impedance tomography in infants to optimize lung monitoring","volume":"195","author":"Miedema","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1053\/j.sempedsurg.2014.09.003","article-title":"Progress in anesthesia and management of the newborn surgical patient","volume":"23","author":"McCann","year":"2014","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/S0022-3468(88)80338-5","article-title":"Right pneumonectomy syndrome: A lethal complication of lung resection in a newborn with cystic adenomatoid malformation","volume":"23","author":"Stolar","year":"1988","journal-title":"J. Pediatr. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.jpedsurg.2015.12.004","article-title":"Thoracoscopic Vs open resection of congenital cystic lung disease- utilization and outcomes in 1120 children in the United States","volume":"51","author":"Polites","year":"2016","journal-title":"J. Pediatr. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1055\/s-0031-1285920","article-title":"Our experience with single lung ventilation in thoracoscopic paediatric surgery","volume":"22","author":"Bataineh","year":"2012","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s12070-016-1026-9","article-title":"Rigid Bronchoscopic Placement of Fogarty Catheter as a Bronchial Blocker for One Lung Isolation and Ventilation in Infants and Children Undergoing Thoracic Surgery: A Single Institution Experience of 27 Cases","volume":"69","author":"Kamra","year":"2017","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1089\/lap.2015.0235","article-title":"Pediatric Thoracoscopy and Bronchial Blockers: The Continued Search for the Ideal One-Lung Ventilation","volume":"26","author":"Cerchia","year":"2016","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/j.1460-9592.1994.tb00414.x","article-title":"Paediatric selective bronchial blocker","volume":"4","author":"Lin","year":"1994","journal-title":"Pediatr. Anesth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1177\/0310057X0203000512","article-title":"Bronchial diameters in children\u2014Use of the Fogarty catheter for lung isolation in children","volume":"30","author":"Tan","year":"2002","journal-title":"Anaesth. Intens. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1093\/bja\/aeh292","article-title":"Experience with the Arndt paediatric bronchial blocker","volume":"94","author":"Wald","year":"2005","journal-title":"Br. J. Anaesth."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1053\/j.jvca.2005.04.011","article-title":"Resection of the Arndt Bronchial Blocker during stapler resection of the left lower lobe","volume":"20","author":"Soto","year":"2006","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e01347","DOI":"10.1213\/XAA.0000000000001347","article-title":"Bronchial Blocker Entrapment in a 7-Month-Old Infant: A Case Report","volume":"14","author":"Templeton","year":"2020","journal-title":"A&A Pract."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/12\/1163\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:43:53Z","timestamp":1760168633000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/12\/1163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,9]]},"references-count":25,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["children8121163"],"URL":"https:\/\/doi.org\/10.3390\/children8121163","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2021,12,9]]}}}