VALUTAZIONE DI UNA NUOVA TECNICA CHIRURGICA PER LA CORREZIONE IN UTERO DELL'ERNIA DIAFRAMMATICA IN UN MODELLO ANIMALE: RISULTATI PRELIMINARI.

The aim of our study is to evaluate a new surgical technique for the in utero correction of the diaphrgmatic hernia (CDH) obcluding the left main bronchus in an animal model (sheep). The first part of the project will be based on the examiantion of the anatomy of the trachea and main bronchi. On the basis of the anatomical records will be developed some devices for its endoluminal obstruction. After that, will be performed the study of the endoscopical anatomy of the lower respiratory tract of the lamb to identify landmarks useful to allow the obstruction of the left main bronchus. The introductions of the devices in the trachea will be performed in three ways: without their direct vision of the catheter (“blind mode”) or under ultrasound or endoscopical guidance. Being the first time that we are working on this disease, a part of the study will be spent to evaluate the effectiveness of techniques for its creation and correction. The rationale of this experiment is based on the fact that the lung ipsilateral to the diaphragmatic lesion is usually the most severely affected by hypoplasia. Obstructing the left main bronchus we suppose to obtain an hyperplastc left lung allowing the right to develop physiologically decreasing the respiratory distress of the newborn. All lambs will be euthanized and their lungs will be used to obtain histological and imunohistological sections to value the number of type II pneumocytes and arterial thickness. The results will be compared between animals with CDH, animals with the correction of the disease achieved by tracheal ligation and healthy animals.