The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Pediatr Res. 2012 Jun;71(6):697-700. doi: 10.1038/pr.2012.16. Epub 2012 Feb 14.
Infants and children with repaired congenital diaphragmatic hernia (CDH) often continue to show delayed growth and development that may be, in part, secondary to unrecognized persistence of increased pulmonary vascular resistance (PVR).
Data were reviewed from all patients ages 6-36 mo with repaired CDH who underwent cardiac catheterization from 2007 to 2010 and were compared to data from a control population of patients undergoing percutaneous closure of a patent ductus arteriosus (PDA). Indexed pulmonary blood flow (Qp), mean pulmonary artery pressure (mPAP), pulmonary capillary wedge pressure (PCWP), and PVR were examined.
Data from 8 CDH patients and 10 control patients were examined. The mPAP (22.5 ± 3.33 vs. 18.2 ± 4.13 mm Hg) and PVR (3.66 ± 0.79 vs. 1.22 ± 0.4 iwU (indexed Wood's units)) were both significantly elevated in the CDH population, whereas the Qp (4.08 ± 1.43 vs. 6.82 ± 1.46 l/min/m(2)) was significantly lower in this population. There was no significant difference in pulmonary capillary wedge pressure (PCWP). Less than half of the CDH patients had signs of pulmonary hypertension (PH) on echocardiogram.
Our data suggest that children who are ages 6-36 mo with repaired CDH have significantly increased PVR compared with controls and early consideration of cardiac catheterization may be warranted.
患有先天性膈疝（CDH）修复的婴儿和儿童经常表现出生长和发育迟缓，部分原因可能是未被识别的肺血管阻力（PVR）持续增加。
回顾了 2007 年至 2010 年期间所有接受心脏导管检查的年龄在 6-36 个月的 CDH 修复患者的数据，并与接受动脉导管未闭（PDA）经皮闭合的患者的对照人群数据进行了比较。检查了指数化肺血流量（Qp）、平均肺动脉压（mPAP）、肺毛细血管楔压（PCWP）和 PVR。
检查了 8 例 CDH 患者和 10 例对照患者的数据。CDH 患者的 mPAP（22.5 ± 3.33 对 18.2 ± 4.13 mmHg）和 PVR（3.66 ± 0.79 对 1.22 ± 0.4 iwU（指数化 Wood 单位））均显著升高，而 Qp（4.08 ± 1.43 对 6.82 ± 1.46 l/min/m(2)）在该人群中显著降低。肺毛细血管楔压（PCWP）无显著差异。不到一半的 CDH 患者在超声心动图上有肺动脉高压（PH）的迹象。
我们的数据表明，年龄在 6-36 个月的 CDH 修复患儿的 PVR 明显高于对照组，早期考虑心脏导管检查可能是必要的。
