Pathophysiology and management of congenital posterolateral diaphragmatic hernias.

Twelve neonates with foramen of Bochdalek hernias were treated at the Medical College of Virginia Hospitals during a recent four-year period. The clinical material supports the concept that bilateral hypoplastic lungs are fundamental in producing a morbid vicious cycle with respiratory and metabolic acidosis, pulmonary hypertension, right to left ductal and parenchymal shunting, worsening of the hypoxia and acidosis, and progression of the cycle. Management of Bochdalek hernias before, during and after operation has been guided by pathophysiologic approach.