Usefulness of echocardiographic measurement of bilateral pulmonary artery dimensions in congenital diaphragmatic hernia

doi:10.1016/0022-3468(94)90726-9

Journal of Pediatric Surgery

Volume 29, Issue 5, May 1994, Pages 622-624

https://doi.org/10.1016/0022-3468(94)90726-9 Get rights and content

Abstract

In nine patients with left-sided congenital diaphragmatic hernia (CDH) developing within 24 hours of birth, the authors measured the dimensions of the bilateral main pulmonary arteries by echocardiography, and investigated whether the left:right main pulmonary artery dimension ratio (PAD ratio) was a useful index for predicting pulmonary hypoplasia and persistent fetal circulation (PFC). Echocardiography was performed shortly after admission, the PAD ratio was calculated, and the clinical course of each patient was determined. When the PAD ratio was approximately 1.0, patients did not suffer from PFC and had little evidence of pulmonary hypoplasia. When the PAD ratio was low, the patients suffered from PFC and had pulmonary hypoplasia on the side of the hernia. Thus, the PAD ratio measured by echocardiography appears to be a useful index for predicting pulmonary hypoplasia and the risk of PFC in patients with CDH.

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Cited by (22)

Predictive value of oxygenation index for outcomes in left-sided congenital diaphragmatic hernia
2018, Journal of Pediatric Surgery
Citation Excerpt :
Recent CDH research has focused on measurement of pulmonary arterial size and pulmonary blood flow as functional lung indices to predict survival and morbidity [8,25,26]. However, the contralateral lung vascular index (Cont-VI) rather than pulmonary artery size was shown to be the most accurate predictor (AUC 89% for survival and 92% for pulmonary hypertension) as pulmonary size discrepancies are anatomic related to pulmonary hypoplasia as opposed to function and pulmonary hypertension [8,27–29]. Oxygenation index has been reported in the literature as a predictor of survival in CDH for two decades.
Congenital Diaphragmatic Hernia (CDH) is associated with significant morbidity and mortality. This study compares the efficacy of the highest oxygenation index in the first 48 h (HiOI) versus current prenatal indices to predict survival and morbidity.
Medical records of 50 prenatally diagnosed, isolated, left-sided CDH patients treated from January 2011 to April 2016 were reviewed. Data abstracted included HiOI, lung to head ratio (LHR), observed to expected total fetal lung volume (O/E TFLV), percent liver herniation (%LH), 6 month survival, respiratory support at discharge, ventilator days and length of stay. Data were analyzed using parametric and nonparametric tests and regression analyses as appropriate.
HiOI was associated with significantly increased LOS (p < 0.001), respiratory support at discharge (p < 0.001), greater ventilator days (p = 0.001) and higher odds of death (p = 0.004) with risk of death increasing by 5% for every one-unit increase in OI. HiOI was statistically a better predictor of LOS than O/E TFLV (p = 0.007) and %LH (p = 0.02).
In isolated, left-sided CDH patients, HiOI is associated with higher mortality, greater length of stay, more ventilator days and increased respiratory support at discharge. HiOI is a better predictor of length of stay than O/E TFLV and %LH.
Retrospective Study
II
Echocardiographic predictors of poor prognosis in congenital diaphragmatic hernia
2016, Journal of Pediatric Surgery
The purpose of this study was to investigate echocardiographic parameters in relation to the outcomes of isolated left-sided congenital diaphragmatic hernia (CDH).
This multicenter, retrospective, observational study was conducted among patients with CDH born between 2006 and 2010. Patients in this study did not have severe cardiac malformations or chromosomal aberrations. Patients with incomplete echocardiographic examinations were excluded. In total, 84 patients with left-sided isolated CDH were included in this study. The prognostic parameters were obtained from postnatal echocardiographic images within 24 h after birth.
Eight patients died before 90 days of birth. Univariate analysis showed that the presence of continuous right to left shunt at the ductus, left pulmonary artery diameter of < 2.7 mm, right pulmonary artery diameter of < 3.3 mm, and left ventricular diastolic diameter of < 10.8 mm, were the predictors of poor prognosis. Multivariate logistic regression analysis showed that right pulmonary artery diameter of < 3.3 mm (adjusted OR 10.28, 95% C.I.: 1.15–249.19) and left ventricular diastolic diameter of < 10.8 mm (adjusted OR 7.86, 95% C.I.: 1.01–82.82) were predictors of poor prognosis.
This study revealed that the predictors of poor prognosis associated with CDH include smaller right pulmonary artery and left ventricular diastolic diameters. Retrospective Study-Level II.
Congenital Diaphragmatic Hernia and Eventration
2012, Pediatric Surgery, 2-Volume Set: Expert Consult - Online and Print
Congenital Diaphragmatic Hernia and Eventration
2012, Pediatric Surgery
Congenital Diaphragmatic Hernia and Eventration
2006, Pediatric Surgery: Sixth Edition
Birth weight and McGoon Index predict mortality in newborn infants with congenital diaphragmatic hernia
2006, Journal of Pediatric Surgery
Despite improvements in clinical management, mortality of congenital diaphragmatic hernia (CDH) remains high. Early prediction of mortality risk helps in comparing strategies and/or performances of different centers. Birth weight (BW), Apgar Score at 5 minutes, and modified McGoon Index (MGI) calculated by the ratio between the diameters of pulmonary arteries and the descending aorta have been used to determine mortality of CDH.
The purpose of this study is to evaluate the relationship between early detectable variables and survival in newborns with CDH intubated at birth, managed with “gentle” ventilation and delayed surgery.
All medical records of patients affected by high-risk CDH and treated with a standardized protocol at Bambino Gesù Children's Hospital, Rome, Italy, between January 2002 and September 2004 were reviewed. Prenatal diagnosis, gestational age, BW, sex, side of hernia, and MGI were recorded on admission. The relationship with mortality of each variable was evaluated by univariate analysis. Subsequently, a predictive model of mortality was developed using a logistic regression: the explanatory variables, BW, and MGI were dichotomized in high (HBW and HMGI) and low (LBW and LMGI) according to the best cutoff found with receiver-operating characteristic curves.
Thirty-four newborns with CDH, treated with a standardized protocol, were studied. The main characteristics of the 34 patients were BW, 2886 g (1500-3620 g); gestational age, 37.7 weeks (32-42 weeks); male/female, 22/12; right/left, 8/26; prenatal diagnosis, 29; MGI, 1.31 (0.9-1.85). Only BW and MGI were significantly (P < .05) associated with mortality at the univariate analysis. The best cutoff values were 2755 g for BW (sensitivity, 70%; specificity, 74%) and 1.25 for MGI (sensitivity, 73%; specificity, 78%). Using these limits, BW and MGI resulted independently associated with mortality in the multivariate analysis. Using the 4 possible combinations, the LBW associated with the LMGI presented the highest prediction of mortality (80%).
Birth weight and MGI, variously combined, were predictive of mortality. Because they are not influenced by subsequent modalities of care, they can be considered as valid early severity scores in CDH and used for comparing strategies and/or performances of different centers.

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^☆: Presented at the 26th Annual Meeting of the Pacific Association of Pediatric Surgeons, Cairns, Queensland, Australia, May 9–14, 1993.

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Usefulness of echocardiographic measurement of bilateral pulmonary artery dimensions in congenital diaphragmatic hernia☆

Abstract

J Pediatr Surg

J Pediatr

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg