Significance of pulmonary artery size and blood flow as a predictor of outcome in congenital diaphragmatic hernia.
OBJECTIVE
To determine if pulmonary artery size and blood flow have prognostic value in congenital diaphragmatic hernia (CDH).


METHODS
Twenty-eight consecutive left-sided CDH patients treated according to a standard protocol with high frequency oscillatory ventilation (HFOV) + nitric oxide (NO) had right and left pulmonary artery (RPA, LPA) diameters, LPA/RPA diameter (L/R) ratios, and PA blood flows examined by echocardiography (EC) on days 0, 2, and 5 after birth and compared prospectively.


RESULTS
Twenty-two patients (78.6%) survived. Of these, 15 required NO (NO-s), and seven did not (non-NO-s). All six patients that died required NO (NO-d). RPA in the NO-d group was significantly smaller than in the NO-s or non-NO-s groups on day 0 (2.90 +/- 0.41 vs. 3.40 +/- 0.49 or 4.01 +/- 0.43; P < 0.01, respectively). LPA in the NO-d group was significantly smaller than in the non-NO-s on day 0 (2.13 +/- 0.45 vs. 3.39 +/- 0.34; P < 0.01). L/R ratios in NO subjects were significantly smaller (NO-s 0.74 +/- 0.11; NO-d 0.73 +/- 0.11) than in non-NO-s subjects (0.84 +/- 0.03) on day 0 (P < 0.01). PA diameters and L/R ratios did not change significantly from day 0 to day 5 in all three groups. There was LPA flow on day 0 in all non-NO-s subjects, but none in all NO subjects. In the NO-s group, LPA flow was confirmed in 87% (13/15) on day 2 and in 100% on day 5, however, there was no LPA flow from day 0 to day 5 in any of the NO-d group.


CONCLUSIONS
Our data indicate that PA diameters on day 0 and LPA flow are strongly prognostic in left-sided CDH and L/R ratio would appear to be a simple highly reliable indicator of the necessity for NO therapy.
Okazaki
Tadaharu
T
Department of Pediatric Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan. okazakit@juntendo.ac.jp
Okawada
Manabu
M
Shiyanagi
Satoko
S
Shoji
Hiromichi
H
Shimizu
Toshiaki
T
Tanaka
Toshitaka
T
Takeda
Satoru
S
Kawashima
Kazunari
K
Lane
Geoffrey J
GJ
Yamataka
Atsuyuki
A
D001783:Blood Flow Velocity; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000503:physiopathology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000098:blood supply*; D008297:Male; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011652:Pulmonary Circulation / Q000502:physiology; D015619:Respiratory System Abnormalities / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology