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Published on: January 27, 2023
Echocardiographic predictors of poor prognosis in congenital diaphragmatic hernia
Masaya Yamoto1, Noboru Inamura2, Keita Terui3
1Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
Insights
Smaller right pulmonary artery and left ventricular diastolic diameters predict poor outcomes in congenital diaphragmatic hernia (CDH) patients. These echocardiographic findings aid in assessing prognosis for isolated left-sided CDH.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Medical Imaging
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring accurate prognostic indicators.
- Echocardiography plays a crucial role in assessing cardiovascular status in neonates.
Purpose of the Study:
- To identify echocardiographic parameters predicting outcomes in isolated left-sided congenital diaphragmatic hernia (CDH).
Main Methods:
- Retrospective, multicenter observational study of 84 neonates with isolated left-sided CDH (2006-2010).
- Exclusion of patients with severe cardiac malformations, chromosomal aberrations, or incomplete echocardiograms.
- Analysis of postnatal echocardiographic images obtained within 24 hours of birth.
Main Results:
- Eight patients (9.5%) died before 90 days of birth.
- Univariate analysis identified right to left ductal shunt, small left pulmonary artery (<2.7mm), small right pulmonary artery (<3.3mm), and small left ventricular diastolic diameter (<10.8mm) as poor prognostic factors.
- Multivariate analysis confirmed small right pulmonary artery diameter (<3.3mm; aOR 10.28) and small left ventricular diastolic diameter (<10.8mm; aOR 7.86) as significant predictors of poor prognosis.
Conclusions:
- Smaller right pulmonary artery and left ventricular diastolic diameters are significant echocardiographic predictors of poor prognosis in isolated left-sided CDH.
- These measurements can assist clinicians in risk stratification and management planning for CDH patients.
Background/Purpose:
The purpose of this study was to investigate echocardiographic parameters in relation to the outcomes of isolated left-sided congenital diaphragmatic hernia (CDH).
Methods:
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 24h after birth.
Results:
Eight patients died before 90days of birth. Univariate analysis showed that the presence of continuous right to left shunt at the ductus, left pulmonary artery diameter of <2.7mm, right pulmonary artery diameter of <3.3mm, and left ventricular diastolic diameter of <10.8mm, were the predictors of poor prognosis. Multivariate logistic regression analysis showed that right pulmonary artery diameter of <3.3mm (adjusted OR 10.28, 95% C.I.: 1.15-249.19) and left ventricular diastolic diameter of <10.8mm (adjusted OR 7.86, 95% C.I.: 1.01-82.82) were predictors of poor prognosis.
Conclusions:
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.
