Successful repair in utero of a fetal diaphragmatic hernia after removal of herniated viscera from the left thorax

MOST infants with congenital diaphragmatic hernia die because their lungs are inadequate to support extrauterine life. This remains true despite advances in postnatal care, including preoperative stabilization,^1,2 pharmacologic treatment of persistent pulmonary hypertension of the newborn,^3,4 and temporary support with extracorporeal membrane oxygenation.^5,6 Recently, prenatal diagnosis has allowed us to define the natural history of fetal diaphragmatic hernia better: approximately 75 percent of fetuses with congenital diaphragmatic hernia detected before birth die despite optimal postnatal care.^{7 8 9 10 11} The neonatal outcome is related to the degree of pulmonary hypoplasia from in utero lung compression, which is determined by the timing and volume.  . .