By Dakshesh Parikh, David Crabbe, Alex Auldist, Steven Rothenberg
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Extra resources for Pediatric Thoracic Surgery
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J Comp Neurol 2003; 455: 477–487. Guilbert TW, Gebb SA, Shannon JM. Lung hypoplasia in the nitrofen model of congenital diaphragmatic hernia occurs early in development. Am J Physiol Lung Cell Mol Physiol 2000; 279: L1159–L1171. Allan DW, Greer JJ. Pathogenesis of nitrofen-induced congenital diaphragmatic hernia in fetal rats. J Appl Physiol 1997; 83: 338–347. You LR, Takamoto N, Yu CT, et al. Mouse lacking COUPTFII as an animal model of Bochdalek-type congenital diaphragmatic hernia. Proc Natl Acad Sci USA 2005; 102: 16351–16356.
The primitive ectoderm fated to become foregut endoderm may receive some information by pattern-forming phenomena before passing through the primitive streak. Cells that then pass through the streak may be further programmed depending upon their head–tail position along the streak and the time when they pass. Cells passing more caudally through the streak may have different genes switched on to those passing through more cranially. Also those passing through early may have different genes switched on compared with those passing through later.
This is relevant when we consider the innervation and motility problems frequently seen in children with repaired EA-TEF. On cross section the esophagus is round at first and then by week 5 it flattens dorsoventrally, cranially, and from side-toside caudally. Longitudinal ridges rotate 90° clockwise as one looks down the esophagus. This rotation is consistent with the rotation of the stomach, which brings the dorsal wall of the stomach to the left. In the 7th and 8th week after fertilization there is marked epithelial proliferation almost occluding the esophagus.