Kailin Joshua A, Dhillon Gurpreet S, Maskatia Shiraz A, Cass Darrell L, Shamshirsaz Alireza A, Mehollin-Ray Amy R, Cassady Christopher I, Ayres Nancy A, Wang Yunfei, Belfort Michael A, Olutoye Oluyinka O, Ruano Rodrigo
Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.
Department of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA.
Prenat Diagn. 2017 May;37(5):502-509. doi: 10.1002/pd.5045. Epub 2017 Apr 27.
Fetuses with congenital diaphragmatic hernia (CDH) demonstrate varying degrees of left heart hypoplasia. Our study assesses the relationship between fetal left-sided cardiac structural dimensions, lung size, percentage liver herniation, lung-to-head ratio, postnatal left-sided cardiac structural dimensions, and postnatal outcomes.
We performed a retrospective cohort study of fetuses with left-sided CDH who had prenatal echocardiographic, ultrasound, and magnetic resonance imaging examinations at our institution between January 2007 and March 2015. Postnatal outcomes assessed include use of inhaled nitric oxide (iNO), use of extracorporeal membrane oxygenation, and death.
Fifty-two fetuses with isolated left-sided CDH were included. Multivariate logistic regression models indicated that smaller fetal aortic valve z-score was associated with postnatal use of iNO (p = 0.03). Fetal mitral valve z-score correlated with lung-to-head ratio (p = 0.04), postnatal mitral valve z-score correlated with percent liver herniation (p = 0.03), and postnatal left ventricular end-diastolic dimension z-score correlated with liver herniation <20% (p = 0.04).
We identified associations between smaller fetal left-sided cardiac structural dimensions and classic CDH indices. Smaller aortic valve z-score was associated with iNO use; however, left heart dimensions showed no association with extracorporeal membrane oxygenation or mortality. Further study into the impact of left-sided hypoplasia on outcomes in CDH is worthy of evaluation in a larger, prospective study. © 2017 John Wiley & Sons, Ltd.
患有先天性膈疝（CDH）的胎儿表现出不同程度的左心发育不全。我们的研究评估胎儿左侧心脏结构尺寸、肺大小、肝脏疝出百分比、肺头比、出生后左侧心脏结构尺寸与出生后结局之间的关系。
我们对2007年1月至2015年3月在本机构接受产前超声心动图、超声和磁共振成像检查的左侧CDH胎儿进行了一项回顾性队列研究。评估的出生后结局包括吸入一氧化氮（iNO）的使用、体外膜肺氧合的使用和死亡。
纳入了52例孤立性左侧CDH胎儿。多变量逻辑回归模型表明，较小的胎儿主动脉瓣z评分与出生后iNO的使用相关（p = 0.03）。胎儿二尖瓣z评分与肺头比相关（p = 0.04），出生后二尖瓣z评分与肝脏疝出百分比相关（p = 0.03），出生后左心室舒张末期内径z评分与肝脏疝出<20%相关（p = 0.04）。
我们确定了较小的胎儿左侧心脏结构尺寸与经典CDH指标之间的关联。较小的主动脉瓣z评分与iNO的使用相关；然而左心尺寸与体外膜肺氧合或死亡率无关。左侧发育不全对CDH结局影响的进一步研究值得在更大规模的前瞻性研究中进行评估。© 2017 John Wiley & Sons, Ltd.
