Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn, Bonn, Germany.
Ultrasound Obstet Gynecol. 2011 Mar;37(3):272-6. doi: 10.1002/uog.7747.
Left heart hypoplasia is commonly observed in fetuses with left diaphragmatic hernia. Because in this condition intrathoracic herniation of the liver serves as an important predictor for postnatal disease severity, we studied its potential association with left heart hypoplasia.
We prospectively assessed 32 fetuses with left diaphragmatic hernia between 19 + 6 and 38 + 6 weeks of gestation using echocardiography. The fetuses were divided into two groups: Group I exhibited an intrathoracic liver position ('liver-up') and Group II an intra-abdominal liver position ('liver-down'). Cardiac inflow and outflow diameter ratios and cardiac Z-scores were compared between the two groups.
Eleven of the 15 Group I (liver-up) fetuses, but only three of the 17 Group II (liver-down) fetuses with left diaphragmatic hernia exhibited predominant left heart hypoplasia with disproportionately smaller left than right heart dimensions (P = 0.0036). In addition, 14 of the 15 Group I fetuses, but only five of the 17 Group II fetuses exhibited preferential streaming of the ductus venosus towards the right heart (P = 0.0003).
In fetuses with left diaphragmatic hernia, intrathoracic liver herniation is commonly associated with predominant left heart hypoplasia, whereas an intra-abdominal liver position is not. This observation may be explained by preferential ductus venosus streaming towards the right heart from elevation and leftward distortion of the normal course of the ductus venosus and inferior vena cava.
左心发育不全在伴有左侧膈疝的胎儿中很常见。由于在这种情况下，肝脏胸腔内疝出是预测出生后疾病严重程度的重要指标，因此我们研究了其与左心发育不全的潜在关联。
我们前瞻性评估了 32 例在 19+6 至 38+6 周妊娠期间患有左侧膈疝的胎儿，使用超声心动图。将胎儿分为两组：组 I 显示胸腔内肝脏位置（“肝上”），组 II 显示腹腔内肝脏位置（“肝下”）。比较两组之间的心脏流入和流出直径比和心脏 Z 评分。
15 例组 I（肝上）胎儿中有 11 例，而 17 例组 II（肝下）胎儿中仅有 3 例表现出主要的左心发育不全，左心比右心尺寸明显较小（P = 0.0036）。此外，15 例组 I 胎儿中有 14 例，而 17 例组 II 胎儿中仅有 5 例表现出静脉导管向右侧心脏的优势血流（P = 0.0003）。
在患有左侧膈疝的胎儿中，胸腔内肝脏疝出通常与主要的左心发育不全有关，而腹腔内肝脏位置则不然。这种观察结果可以通过静脉导管和下腔静脉正常路径的抬高和左向扭曲导致静脉导管向右侧心脏的优势血流来解释。
