title: Echocardiographic measures of ventricular function and pulmonary artery size: prognostic markers of congenital diaphragmatic hernia?
abstract: OBJECTIVE
  To compare echocardiographic measures of biventricular function and pulmonary artery size in infants with congenital diaphragmatic hernia (CDH) and normal controls, and examine their correlation, if any, with outcomes in CDH.
  
  
  METHODS
  We included consecutive neonates (<1 month old) with CDH and term controls without structural heart defects. Clinical and outcomes data were recorded and echocardiograms evaluated for right ventricular (RV) and left ventricular (LV) myocardial performance index (MPI), cardiac output index (CI) and McGoon index, among others. Statistical analyses (SPSS version 17, SPSS, Chicago, IL, USA) included between-group comparisons, using analysis of variance and χ(2)-test and binary regression, with significance set at P<0.05.
  
  
  RESULTS
  Infants with CDH (n=34) were comparable with controls (n=35) in their age, weight, gestational age and gender. CDH was left sided in 24 (70%) neonates. Extracorporeal membrane oxygenation (ECMO) was required in 15 (45%) neonates; 18 (53%) infants survived. MPIs, CI and eccentricity index in systole were significantly worse in the CDH group, compared with controls and among CDH infants who died, compared with survivors. Infants with CDH who died or needed ECMO had significantly impaired MPIs and CI than survivors. On regression analyses, LV CI and MPIs were independently associated with mortality.
  
  
  CONCLUSIONS
  Infants with CDH had significantly impaired ventricular function and pulmonary hypertension, compared with controls. In the CDH group, LV dysfunction was associated with death and adverse outcomes. Further studies incorporating echocardiographic indices as prognostic markers of CDH are warranted.
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, MI 48201, USA. ssanjeev@dmc.org
authors.forename: S
authors.initials: S
authors.lastname: Aggarwal
authors.forename: P
authors.initials: P
authors.lastname: Stockmann
authors.forename: M D
authors.initials: MD
authors.lastname: Klein
authors.forename: G
authors.initials: G
authors.lastname: Natarajan
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006439:Hemodynamics; D006548:Hernia, Diaphragmatic / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000453:epidemiology*; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*