title: Cardiac Adaptation to Severe Congenital Diaphragmatic Hernia.
abstract: OBJECTIVE
  Prenatal heart adaptations to congenital diaphragmatic hernia (CDH) could help define postnatal outcome.
  
  
  METHODS
  We retrospectively analyzed post-mortem tissues from fetuses with severe CDH (n = 7). Histology and immunohistochemical distribution of desmin, muscle actin [HHF35], endothelin-1 [ET-1] and TGF-β were evaluated.
  
  
  RESULTS
  In the atrium, desmin, HHF35, ET-1, TGF-β were found expressed only in preterm CDH. Dishomogeneous ventricular distribution of cardiac growth factors were detected in term CDH. The cardiomyocyte nucleus/cytoplasmatic ratio in CDH was higher compared with controls (p = 0.01). Small intramyocardial artery density and vascular wall thickness was increased in CDH compared with controls (p = 0.03 and p < 0.01). In comparison with the ventricles, the interventricular septum showed a greater vessel density (p = 0.01) and a greater vascular wall thickness, particularly compared with the CDH right ventricle (p = 0.02).
  
  
  CONCLUSIONS
  Left ventricle immaturity seems to be a cardiac adaptive response of severe CDH in utero.
authors.affiliation: a Pediatric Surgery Unit , Fondazione IRCCS Policlinico S. Matteo and University of Pavia , Pavia , Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Pelizzo
authors.affiliation: b Institute of Pathologic Anatomy , University of Trieste , Trieste , Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Bussani
authors.affiliation: b Institute of Pathologic Anatomy , University of Trieste , Trieste , Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Zandonà
authors.affiliation: b Institute of Pathologic Anatomy , University of Trieste , Trieste , Italy.
authors.forename: Ana
authors.initials: A
authors.lastname: Custrin
authors.affiliation: c Policlinico Le Scotte, Neonatal Intensive Care Unit , University of Siena, Siena , Italy.
authors.forename: Carlo Valerio
authors.initials: CV
authors.lastname: Bellieni
authors.affiliation: d Fondazione IRCCS Policlinico San Matteo, Scientific Direction, Biometry & Clinical Epidemiology , Pavia , Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: De Silvestri
authors.affiliation: e Pediatric Unit, University of Pavia and Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Calcaterra
mesh_terms: D006352:Heart Ventricles / Q000473:pathology*; D065630:Hernias, Diaphragmatic, Congenital / Q000378:metabolism*; D006801:Humans; D008168:Lung / Q000002:abnormalities; D011651:Pulmonary Artery / Q000473:pathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016212:Transforming Growth Factor beta / Q000378:metabolism
chemical_list: D016212:Transforming Growth Factor beta
keywords: congenital diaphragmatic hernia; fetal; growth; heart; remodeling