title: Preferential streaming of the ductus venosus toward the right atrium is associated with a worse outcome despite a higher rate of invasive procedures in human fetuses with left diaphragmatic hernia.
abstract: OBJECTIVE
  Preferential streaming of the ductus venosus (DV) toward the right atrium has been observed in fetuses with left diaphragmatic hernia (LDH). The purpose of this retrospective study was to compare survival rates to discharge between a group with preferential streaming of the DV toward the right heart and a group in which this abnormal flow pattern was not present.
  
  
  METHODS
  We retrospectively searched our patient records for fetuses with LDH in whom liver position, DV streaming and postnatal outcome information was available. 55 cases were found and divided into two groups: Group I fetuses exhibited abnormal DV streaming toward the right side of the heart; group II fetuses did not. Various prognostic and outcome parameters were compared.
  
  
  RESULTS
  62 % of group I fetuses and 88 % of group II fetuses survived to discharge (p = 0.032). Fetoscopic tracheal balloon occlusion (FETO) was performed in 66 % of group I fetuses and 23 % of group II fetuses (p = 0.003). Postnatal ECMO therapy was performed in 55 % of group I fetuses and 23 % of group II infants (p = 0.025). Moderate to severe chronic lung disease in survivors was observed in 56 % of the survivors of group I and 9 % of the survivors of group II (p = 0.002).
  
  
  CONCLUSIONS
  Preferential streaming of the DV toward the right heart in human fetuses with left-sided diaphragmatic hernia was associated with a poorer postnatal outcome despite a higher rate of invasive pre- and postnatal procedures compared to fetuses without this flow abnormality. Specifically, abnormal DV streaming was found to be an independent predictor for FETO.
authors.affiliation: Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn.
authors.forename: R
authors.initials: R
authors.lastname: Stressig
authors.affiliation: Department of Biostatistics, University Hospital of Bonn.
authors.forename: R
authors.initials: R
authors.lastname: Fimmers
authors.affiliation: Department of Neonatology, University Hospital of Mannheim, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schaible
authors.affiliation: Department of Obstetrics and Prenatal Medicine, University Hospital of Gießen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Degenhardt
authors.affiliation: Department of Obstetrics and Prenatal Medicine, University Hospital of Gießen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Axt-Fliedner
authors.affiliation: Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Gembruch
authors.affiliation: German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT), University Hospital of Gießen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Kohl
mesh_terms: D018618:Echocardiography, Doppler, Color; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005865:Gestational Age; D006325:Heart Atria / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000196:embryology* / Q000401:mortality / Q000628:therapy; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging* / Q000196:embryology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D010547:Persistent Fetal Circulation Syndrome / Q000000981:diagnostic imaging* / Q000196:embryology* / Q000401:mortality / Q000628:therapy; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016216:Ultrasonography, Prenatal; D014471:Umbilical Veins / Q000000981:diagnostic imaging*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*