Perioperative biventricular function in congenital diaphragmatic hernia: a three-dimensional echocardiographic study

Cardiac dysfunction is increasingly recognized as an important feature in congenital diaphragmatic hernia (CDH); however, detailed longitudinal data describing perioperative biventricular adaptation remain limited.

This single-center retrospective study included 49 infants who underwent CDH surgery between 2017 and 2024. Three-dimensional echocardiography was used to measure left ventricular (LV) and right ventricular (RV) end-diastolic volume (LVEDV and RVEDV, respectively), ejection fraction (EF), and cardiac output at 1-3 days of age, preoperatively, and at <18 h and 24-72 h postoperatively.

At 1-3 days of age, LV parameters showed minimal changes. RVEF increased (37.5% to 45.5%; P < 0.001), with reductions in RV end-systolic volume and improved ventricular-arterial coupling. The LVEDV/RVEDV ratio increased from 0.65 ± 0.18 (1 day of age) to 0.74 ± 0.24 (preoperatively) (P = 0.001). Postoperatively (24-72 h), indexed ventricular and stroke volumes increased compared with preoperative measurements; LVEDV increased from 1.32 mL/kg to 1.51 mL/kg (P = 0.008) and RVEDV from 1.82 mL/kg to 2.07 mL/kg (P = 0.013).

Preoperatively, RV systolic performance and RV-pulmonary arterial coupling improved, possibly reflecting the effects of management and/or physiological adaptation. After repair, biventricular end-diastolic and stroke volumes increased, consistent with enhanced postoperative ventricular filling.

This study is the first to serially evaluate biventricular volumes and function from birth through the perioperative period in infants with congenital diaphragmatic hernia (CDH) using three-dimensional echocardiography. Preoperatively, right ventricular-pulmonary arterial coupling improved over time. Surgical repair was associated with increases in biventricular end-diastolic volumes and stroke volumes in the early postoperative phase, consistent with enhanced ventricular filling. This study provides novel physiological insights into the distinct adaptive mechanisms of both ventricles, which may have valuable implications for perioperative management.