title: Increase in fetal pulmonary artery diameters during late gestation is a predictor of outcome in congenital diaphragmatic hernia with liver herniation.
abstract: OBJECTIVE
  Liver herniation (LH) in congenital diaphragmatic hernia (CDH) may not be a reliable prognostic indicator. We measured pulmonary artery (PA) diameters in CDH + LH as an alternative.
  
  
  METHODS
  Of 41 consecutive cases of prenatally diagnosed left-sided CDH treated from 2002 to 2010, 19 had CDH + LH and 22 had CDH - LH. Ultrasonography and magnetic resonance imaging were used to assess LH and echocardiography to measure PA diameters during the third trimester (fetal; 32-34 weeks), at birth, and on day 2 of life.
  
  
  RESULTS
  In CDH + LH survivors (9/19; 47%), fetal right PA (RPA) diameters were significantly larger than in nonsurvivors (2.58 ± 0.56 vs 1.82 ± 0.35 mm; P < .01), but left PA (LPA) diameters were not (1.73 ± 0.38 vs 1.59 ± 0.22). In survivors, fetal RPA was greater than 2 mm in all but one case, and both PA diameters increased significantly by birth (RPA, 2.58 ± 0.56 vs 3.52 ± 0.54; LPA, 1.73 ± 0.38 vs 2.60 ± 0.40; both P < .01). Final diameters at birth in survivors were at least 2.5 and 2.0 mm, respectively. In nonsurvivors, both PAs were significantly smaller (RPA, 3.52 ± 0.54 vs 2.04 ± 0.31; LPA, 2.60 ± 0.40 vs 1.68 ± 0.18; P < .01), with no observed increase by birth. Survival in CDH - LH was 82% (18/22).
  
  
  CONCLUSIONS
  PA diameter appears to be correlated with prognosis in infants with CDH + LH.
authors.affiliation: Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan. okazakit@juntendo.ac.jp
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Nana
authors.initials: N
authors.lastname: Nakazawa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ogasawara
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Shoji
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Shintaro
authors.initials: S
authors.lastname: Makino
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeda
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D000015:Abnormalities, Multiple; D001724:Birth Weight; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging; D018618:Echocardiography, Doppler, Color; D005260:Female; D005865:Gestational Age; D006547:Hernia / Q000000981:diagnostic imaging / Q000196:embryology / Q000209:etiology*; D006548:Hernia, Diaphragmatic / Q000473:pathology / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D059685:Herniorrhaphy; D006801:Humans; D007231:Infant, Newborn; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000196:embryology / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000196:embryology* / Q000473:pathology; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging; D016216:Ultrasonography, Prenatal