Schwartz S M, Vermilion R P, Hirschl R B
Department of Pediatrics, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor.
J Pediatr. 1994 Sep;125(3):447-51. doi: 10.1016/s0022-3476(05)83293-7.
To evaluate left ventricular (LV) mass in children with left-sided congenital diaphragmatic hernia (CDH), we retrospectively examined the echocardiographic data available on all newborn infants with a diagnosis of CDH between April 1989 and May 1993. Adequate data for evaluation were available for 20 of 31 patients with left-sided CDH and no significant congenital heart disease. Left ventricular mass was determined from two-dimensional echocardiograms by an area-length method. Findings were compared with a control group that consisted of neonates with other causes of pulmonary hypertension. Patients with left-sided CDH had a significantly lower indexed LV mass than control subjects (1.96 gm/kg +/- 0.59 vs 2.84 gm/kg +/- 0.41; p = 0.0001). Additionally, children with left-sided CDH who required extracorporeal membrane oxygenation before repair (n = 7) had a significantly lower indexed LV mass than those patients who did not require extracorporeal membrane oxygenation before repair (1.53 gm/kg +/- 0.50 vs 2.20 gm/kg +/- 0.52; (p = 0.007). Infants who survived (n = 13) had an indexed LV mass of 2.09 gm/kg +/- 0.58 vs 1.64 gm/kg +/- 0.58 in those who died (p = 0.07). We conclude that the LV mass index in children with left-sided CDH is significantly lower than in children with other causes of pulmonary hypertension in the newborn period. Evaluation of LV mass in neonates with left-sided CDH may help predict the need for extracorporeal support before surgical repair, and may help indicate overall prognosis.
为评估左侧先天性膈疝（CDH）患儿的左心室（LV）质量，我们回顾性检查了1989年4月至1993年5月期间所有诊断为CDH的新生儿的超声心动图数据。31例左侧CDH且无显著先天性心脏病的患者中，20例有可供评估的充分数据。通过面积-长度法从二维超声心动图确定左心室质量。将结果与由其他原因导致肺动脉高压的新生儿组成的对照组进行比较。左侧CDH患者的左心室质量指数显著低于对照组（1.96克/千克±0.59 vs 2.84克/千克±0.41；p = 0.0001）。此外，在修复前需要体外膜肺氧合的左侧CDH患儿（n = 7）的左心室质量指数显著低于那些在修复前不需要体外膜肺氧合的患者（1.53克/千克±0.50 vs 2.20克/千克±0.52；（p = 0.007）。存活的婴儿（n = 13）的左心室质量指数为2.09克/千克±0.58，而死亡婴儿的为1.64克/千克±0.58（p = 0.07）。我们得出结论，新生儿期左侧CDH患儿的左心室质量指数显著低于其他原因导致肺动脉高压的患儿。评估左侧CDH新生儿的左心室质量可能有助于预测手术修复前对体外支持的需求，并可能有助于指示总体预后。
