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Fetal cardiac dimensions in congenital diaphragmatic hernia: relationship with gestational age and postnatal outcomes
Anna Claudia Massolo1, Anita Romiti2, Milena Viggiano2
1Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. annaclaudia.massolo@opbg.net.
Insights
Fetal cardiac measurements, including mitral valve diameter (MVD), are reduced in congenital diaphragmatic hernia (CDH). Smaller MVDs in early gestation may predict severe CDH outcomes.
Area of Science:
- Fetal cardiology
- Congenital abnormalities
- Neonatal outcomes
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition affecting fetal development.
- Cardiac anomalies are frequently observed in fetuses with CDH.
- Understanding fetal cardiac changes is crucial for predicting CDH severity.
Purpose of the Study:
- To serially assess fetal cardiac dimensions in congenital diaphragmatic hernia (CDH).
- To determine the relationship between fetal cardiac dimensions and CDH disease severity.
Main Methods:
- Retrospective analysis of CDH cases and matched controls.
- Serial assessment of mitral valve diameter (MVd), tricuspid valve diameter (TVd), left ventricular (LV) length and area, and their Z-scores.
- Measurements taken at 24-26, 30-32, and 35-37 weeks gestational age (GA).
Main Results:
- CDH cases showed significantly reduced MVd, MVd Z-score, and LV area at 24-26 and 35-37 weeks GA.
- Reduced TVd, TVd Z-score, and RV area were observed at 24-26 weeks GA in CDH.
- Lower MVd and MVd Z-scores at 24-26 weeks GA were associated with combined outcomes of death and/or extracorporeal membrane oxygenation (ECMO).
Conclusions:
- Left ventricular (LV) hypoplasia in CDH is indicated by reduced MVd from 24 weeks GA.
- MVd and the ratio of mitral to tricuspid valve diameters may predict CDH disease severity.
Objective:
To serially assess fetal cardiac dimensions in congenital diaphragmatic hernia (CDH) and their relation to disease severity.
Study Design:
Retrospective analysis of CDH cases and matched controls. Mitral (MVd) and tricuspid (TVd) valve diameters, left (LV) and right (RV) ventricular length and area, Z-scores, were serially assessed at 24-26, 30-32, and 35-37 weeks gestational age (GA).
Results:
In CDH cases MVd, MVd Z-score, and LV area were significantly reduced at 24-26 and 35-37 weeks GA. TVd, TVd Z-score, and RV area were significantly reduced at 24-26 weeks. RV area Z-score increased with advancing GA. MVd and MVd Z-score were significantly lower at 24-26 weeks GA in CDH who had a combined outcome of death and/or ECMO.
Conclusions:
LV hypoplasia in CDH is characterized by reduced MVd from 24 weeks GA. MVd, and the ratio of mitral and tricuspid valve diameters at later gestations, may be potential predictors of disease severity.
