Patel Neil, Kipfmueller Florian
Neonatal Unit, Royal Hospital for Children, 1345 Govan Rd, Glasgow G51 3TF, UK.
Children's Hospital University, Bonn, Germany.
Semin Pediatr Surg. 2017 Jun;26(3):154-158. doi: 10.1053/j.sempedsurg.2017.04.001. Epub 2017 Apr 25.
Cardiac dysfunction is an important consequence of pulmonary hypertension in congenital diaphragmatic hernia and a determinant of disease severity. Increased afterload leads to right ventricular dilatation and diastolic dysfunction. Septal displacement and dysfunction impair left ventricular function, which may also be compromised by fetal hypoplasia. Biventricular failure contributes to systemic hypotension and hypoperfusion. Early and regular echocardiographic assessment of cardiac function and pulmonary artery pressure can guide therapeutic decision-making, including choice and timing of pulmonary vasodilators, cardiotropes, ECMO, and surgery.
心脏功能障碍是先天性膈疝中肺动脉高压的重要后果，也是疾病严重程度的决定因素。后负荷增加导致右心室扩张和舒张功能障碍。室间隔移位和功能障碍损害左心室功能，胎儿发育不全也可能使其受损。双心室衰竭导致全身低血压和灌注不足。对心脏功能和肺动脉压力进行早期、定期的超声心动图评估可指导治疗决策，包括肺血管扩张剂、强心剂、体外膜肺氧合（ECMO）和手术的选择及时机。
