[Pulmonary hypertension and fetal circulation after severe congenital diaphragmatic hernia (author's transl)]. / Hypoxémie réfractaire par hypertension artérielle pulmonaire et circulation de type foetal dans les hernies congénitales de la coupole gauche à révélation néonatale. Physiopathologie et traitement à propos de quatre observations.

The authors present four new born with severe anoxemia after congenital diaphragmatic hernia repair. In three babies' hypoxemia was present from birth. Cardiac catheterization revealed pulmonary hypertension, resulting in a state of fetal circulation. Tolazoline produced an improvement in oxygenation, but became secondary ineffective. In one case ductus arteriosus was occluded during cardiac catheterization, after which immediate improvement in peripheral oxygenation was seen. Ligation of the patient ductus arteriosus was proposed in that case. In the fourth infant, hypoxemia developed secondary and was successfully treated with tolazoline. It is suggested that ligation of the patient ductus arteriosus and administration of pulmonary vasodilatators are both effective in improving oxygenation, in patients who may die an anoxic death after repair of a severe congenital diaphragmatic hernia.