title: Efficacy of the circulatory management of an antenatally diagnosed congenital diaphragmatic hernia: outcomes of the proposed strategy.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the outcome of our therapeutic strategy for antenatally diagnosed congenital diaphragmatic hernia (ADCDH).
  
  
  METHODS
  We treated 61 cases of ADCDH according to our strategy. Prostaglandin E1 was required to be maintained the patency of the ductus arteriosus (PDA) in 39 cases (Group I) while it was not administered in 22 cases (Group II). Left ventricular end-diastolic dimension (LVDD) and Tei index were measured with echocardiography on days 0, 2, and 7 after birth. Radical surgery was performed on all cases by day 2.
  
  
  RESULTS
  On day 0, Group I showed smaller LVDD and Tei index than those in Group II. Between day 0 and day 2, these parameters increased significantly in Group I, but not in Group II. On day 7, no significant difference in these parameters was observed between the two groups. Five patients died of cardiac and respiratory failure, resulting in a survival rate of 92 %.
  
  
  CONCLUSIONS
  Our therapeutic strategy improves the clinical outcome of ADCDH. This can be attributed to two factors: earlier surgery resulting in improved LV function. The latter attenuates pulmonary hypertension and maintains PDA with a consequent decrease in right ventricular afterload to compensate for the low cardiac output resulting from PDA.
authors.affiliation: Department of Pediatric Cardiology, and Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan, inamura@mch.pref.osaka.jp.
authors.forename: Noboru
authors.initials: N
authors.lastname: Inamura
authors.forename: Akio
authors.initials: A
authors.lastname: Kubota
authors.forename: Ryo
authors.initials: R
authors.lastname: Ishii
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Ishii
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kawazu
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hamamichi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoneda
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Kawahara
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Okuyama
authors.forename: Futoshi
authors.initials: F
authors.lastname: Kayatani
mesh_terms: D000527:Alprostadil / Q000627:therapeutic use; D019468:Disease Management; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging / Q000187:drug effects; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011652:Pulmonary Circulation / Q000502:physiology*; D016019:Survival Analysis; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014654:Vascular Patency / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D000527:Alprostadil
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