Fetal Surgery for Congenital Diaphragmatic Hernia

Diaphragmatic hernia occurs when any of the four separate structures making up the diaphragm (the septum transversum, pleuroperitoneal membranes, dorsal mesentery of the esophagus, and body wall) fail to grow toward each other or to fuse by the eighth week after conception. The resulting diaphragmatic defect becomes a portal through which abdominal structures can herniate into the thorax (see Figure). In many cases, abdominal organs slide in and out of the thorax intermittently throughout gestation, with apparently little permanent effect on the developing lungs and heart. If there are no other anomalies and the defect is not part of a . . .