title: Left heart structures in human neonates with congenital diaphragmatic hernia and the effect of fetal endoscopic tracheal occlusion.
abstract: BACKGROUND
  Small left heart structures are observed in fetuses with left-sided congenital diaphragmatic hernia (CDH). Fetoscopic tracheal occlusion (FETO) in mid-gestation promotes lung growth in fetuses with CDH, however cardiac effects of FETO are poorly described. We studied the effects of FETO on cardiac structure size at birth, hypothesizing that left heart structures would be larger in neonates who had undergone fetal intervention.
  
  
  RESULTS
  We performed retrospective measurements of atrioventricular and semilunar valve and pulmonary artery diameters, ventricular lengths, left ventricular end-diastolic volume indexed (LVEDVi) to body surface area. 35 patients were studied (9 FETO, 26 controls). All fetuses had liver herniation and a lung-to-head ratio <1 at fetal presentation. At birth the intervention group had larger LVEDVi (16.8 vs. 12.76 ml/m(2), p < 0.05), LV length Z-score (-2.05 vs. -4, p < 0.01), LV:RV length ratio (1.43 vs. 1.04, p < 0.05), LPA diameter Z-score (+1.71 vs. -1.04, p < 0.05), and better growth of aortic valve (-2.18 FETO, -3.3 controls, p < 0.01). There was a trend toward higher LV output in the FETO group.
  
  
  CONCLUSIONS
  Left heart structures and LPA were larger postnatally in patients with CDH who underwent FETO than in those who did not. Hemodynamic alterations are introduced with tracheal occlusion that are associated with alterations in ventricular loading and may influence growth.
authors.affiliation: Department of Obstetrics, Division of Fetal Cardiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Luciane Alves da
authors.initials: LA
authors.lastname: Rocha
authors.forename: Francesca A
authors.initials: FA
authors.lastname: Byrne
authors.forename: Roberta L
authors.initials: RL
authors.lastname: Keller
authors.forename: Doug
authors.initials: D
authors.lastname: Miniati
authors.forename: Michael M
authors.initials: MM
authors.lastname: Brook
authors.forename: Norman H
authors.initials: NH
authors.lastname: Silverman
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Moon-Grady
mesh_terms: D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D047109:Fetal Development; D005332:Fetoscopy; D006257:Head / Q000000981:diagnostic imaging; D006321:Heart / Q000196:embryology; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D012039:Regional Blood Flow; D012189:Retrospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal