Contribution of intrapulmonary artery Doppler to improve prediction of survival in fetuses with congenital diaphragmatic hernia treated with fetal endoscopic tracheal occlusion.
OBJECTIVE
To evaluate the contribution of intrapulmonary artery Doppler in predicting the survival of fetuses with congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO).


METHODS
A cohort of 41 fetuses (between 24 and 28 weeks of gestation) with CDH was treated with FETO. The observed/expected lung-to-head ratio (O/E-LHR), pulmonary artery pulsatility index (PI), peak early diastolic reversed flow (PEDRF) and peak systolic velocity (PSV) were evaluated before FETO, and their isolated and combined value to predict survival using multiple logistic regression and decision-tree analysis was assessed.


RESULTS
O/E-LHR and intrapulmonary artery PI and PEDRF were significantly associated with the probability of survival (O/E-LHR > or = 26%, OR 14.2; PI < 1 Z-score, OR 8.4; and PEDRF < 3.5 Z-scores, OR 5.7). Decision-tree analysis showed that O/E-LHR was the best initial predictor of prognosis (O/E-LHR > or = 26%, 90% survival; O/E-LHR < 26%, 45% survival). For fetuses with an O/E-LHR of < 26%, Doppler parameters allowed discrimination of cases with moderate (66-71% survival) and very poor (0% survival) prognosis.


CONCLUSIONS
Intrapulmonary artery Doppler evaluation helps to refine the prediction of survival after FETO in fetuses with severe CDH.
Cruz-Martinez
R
R
Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
Moreno-Alvarez
O
O
Hernandez-Andrade
E
E
Castañon
M
M
Done
E
E
Martinez
J M
JM
Puerto
B
B
Deprest
J
J
Gratacos
E
E
D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D005865:Gestational Age; D006257:Head / Q000000981:diagnostic imaging* / Q000196:embryology; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging* / Q000196:embryology / Q000401:mortality / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000196:embryology; D008297:Male; D009929:Organ Size; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D016019:Survival Analysis; D014132:Trachea / Q000000981:diagnostic imaging* / Q000196:embryology / Q000601:surgery; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal / Q000379:methods