title: Association between intrapulmonary arterial Doppler parameters and degree of lung growth as measured by lung-to-head ratio in fetuses with congenital diaphragmatic hernia.
abstract: OBJECTIVE
  To describe the association between the intrapulmonary circulation and the degree of lung growth in fetuses with congenital diaphragmatic hernia (CDH).
  
  
  METHODS
  Thirty-six fetuses with isolated left CDH at 22-29 weeks of gestation were studied. Four groups were defined according to lung-to-head ratio (LHR), expressed as the ratio of observed to expected LHR for gestational age (O/E LHR). Pulsatility index (PI), peak systolic velocity (PSV), peak early-diastolic reversed flow (PEDRF), end-diastolic velocity (EDV), acceleration time (AT), time averaged velocity (TAV) and the ratio AT to ejection time (AT/ET) were measured in all fetuses in the proximal arterial branch of both lungs. For analysis, Doppler values were converted to Z-scores.
  
  
  RESULTS
  It was possible to record all Doppler parameters from the contralateral lung of all CDH fetuses, and from the ipsilateral lung in 28 (77.7%). PEDRF significantly increased in relation to the decrease in O/E LHR in both lungs (contralateral: r = - 0.65, P = 0.01; ipsilateral: r = - 0.43, P = 0.02). PI increased significantly with the reduction in O/E LHR but only on the side contralateral to the hernia (r = - 0.55, P = 0.02). In the ipsilateral pulmonary artery, PI values showed a significant overall increase but no differences were observed among the O/E LHR groups. PSV, EDV and TAV were reduced in both lungs with respect to normal values, but no association was found with the O/E LHR. No changes in AT or AT/ET were observed in either lung.
  
  
  CONCLUSIONS
  PEDRF is quick and easy to calculate, and showed the strongest and most consistent correlation with O/E LHR. The association between PEDRF and LHR might be an additional parameter that could help to establish prognosis in fetuses with CDH.
authors.affiliation: Fetal and Perinatal Medicine Research Group, Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Moreno-Alvarez
authors.forename: E
authors.initials: E
authors.lastname: Hernandez-Andrade
authors.forename: D
authors.initials: D
authors.lastname: Oros
authors.forename: J
authors.initials: J
authors.lastname: Jani
authors.forename: J
authors.initials: J
authors.lastname: Deprest
authors.forename: E
authors.initials: E
authors.lastname: Gratacos
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006257:Head / Q000000981:diagnostic imaging / Q000196:embryology*; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000196:embryology; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000196:embryology*; D011247:Pregnancy; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal / Q000379:methods