title: Right-sided congenital diaphragmatic hernia in a decade of fetal surgery.
abstract: OBJECTIVE
  To report a recent update on fetuses with right-sided congenital diaphragmatic hernia (RCDH) in the era of fetal surgery.
  
  
  METHODS
  Retrospective review of prospectively collected data.
  
  
  METHODS
  Fetal treatment centres in Leuven and Barcelona.
  
  
  METHODS
  Consecutive cases of RCDH between 2002 and 2012.
  
  
  METHODS
  Data on prenatal imaging, genetic testing, pregnancy and neonatal outcomes were extracted from our databases, including structural and genetic anomalies, candidate outcome predictors such as lung size, liver herniation ratio, polyhydramnios, cervical length, preterm prelabour rupture of membranes and gestational age at birth.
  
  
  METHODS
  Survival and oxygen dependency at discharge.
  
  
  RESULTS
  Ten out of 86 fetuses with RCDH had associated abnormalities. Of 76 isolated pregnancies, eight women opted for termination of pregnancy, most with severe hypoplasia and one was lost to follow up. Nineteen pregnancies were expectantly managed and delivered at a mean gestational age of 36.0 ± 3.0 weeks. Survival at discharge was 53% (10/19), one being oxygen dependent. In the fetal surgery group (n = 48), mean gestational age at delivery was 34.5 ± 3.0 weeks. In our recent experience not previously published (n = 23) survival rate was 52 and 39% were oxygen dependent at discharge. Pooling these data with earlier reported observations by our group we observed a 42% survival rate in 57 fetuses. Lung size on magnetic resonance imaging and an interval of >24 hours between reversal of tracheal occlusion and delivery were predictors of outcome.
  
  
  CONCLUSIONS
  Right-sided CDH seems to have a poorer outcome than that reported for fetuses with left-sided CDH with similar lung size before birth. Survival rates after expectant management with observed/expected lung-to-head ratio values ≤45 and ≤30% were 17 and 0%, respectively. In those undergoing fetal surgery (observed/expected lung-to-head ratio ≤45%) there was an apparent increase (42%).
authors.affiliation: Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.|Department of Development and Regeneration, Cluster Organ Systems, KU Leuven, Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: DeKoninck
authors.affiliation: Maternal-Fetal Medicine Department, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia (ICGON), Hospital Clínic, Institut d'Investigacions Biomédiques Augusto Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Gomez
authors.affiliation: Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.|Department of Development and Regeneration, Cluster Organ Systems, KU Leuven, Leuven, Belgium.|Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Sandaite
authors.affiliation: Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.|Department of Development and Regeneration, Cluster Organ Systems, KU Leuven, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Richter
authors.affiliation: Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.|Department of Development and Regeneration, Cluster Organ Systems, KU Leuven, Leuven, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Nawapun
authors.affiliation: Department of Development and Regeneration, Cluster Organ Systems, KU Leuven, Leuven, Belgium.|Department of Paediatrics, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Eerdekens
authors.affiliation: Maternal-Fetal Medicine Department, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia (ICGON), Hospital Clínic, Institut d'Investigacions Biomédiques Augusto Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Ramirez
authors.affiliation: Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Claus
authors.affiliation: Maternal-Fetal Medicine Department, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia (ICGON), Hospital Clínic, Institut d'Investigacions Biomédiques Augusto Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Gratacos
authors.affiliation: Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.|Department of Development and Regeneration, Cluster Organ Systems, KU Leuven, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Deprest
mesh_terms: D005260:Female; D005315:Fetal Diseases / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000033:anatomy & histology; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
keywords: Congenital diaphragmatic hernia; fetal therapy; magnetic resonance imaging; tracheal occlusion; ultrasound