Echocardiographic predictors of poor prognosis in congenital diaphragmatic hernia.
OBJECTIVE
The purpose of this study was to investigate echocardiographic parameters in relation to the outcomes of isolated left-sided congenital diaphragmatic hernia (CDH).


METHODS
This multicenter, retrospective, observational study was conducted among patients with CDH born between 2006 and 2010. Patients in this study did not have severe cardiac malformations or chromosomal aberrations. Patients with incomplete echocardiographic examinations were excluded. In total, 84 patients with left-sided isolated CDH were included in this study. The prognostic parameters were obtained from postnatal echocardiographic images within 24h after birth.


RESULTS
Eight patients died before 90days of birth. Univariate analysis showed that the presence of continuous right to left shunt at the ductus, left pulmonary artery diameter of <2.7mm, right pulmonary artery diameter of <3.3mm, and left ventricular diastolic diameter of <10.8mm, were the predictors of poor prognosis. Multivariate logistic regression analysis showed that right pulmonary artery diameter of <3.3mm (adjusted OR 10.28, 95% C.I.: 1.15-249.19) and left ventricular diastolic diameter of <10.8mm (adjusted OR 7.86, 95% C.I.: 1.01-82.82) were predictors of poor prognosis.


CONCLUSIONS
This study revealed that the predictors of poor prognosis associated with CDH include smaller right pulmonary artery and left ventricular diastolic diameters. Retrospective Study-Level II.
Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan. Electronic address: smashace1018@yahoo.co.jp.
Masaya
M
Yamoto
Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Noboru
N
Inamura
Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Keita
K
Terui
Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan.
Kouji
K
Nagata
Division of Surgery, National Center for Child Health and Development, Tokyo, Japan.
Yutaka
Y
Kanamori
Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
Masahiro
M
Hayakawa
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Yuko
Y
Tazuke
Department of Pediatric Surgery, Hyogo Children's Hospital, Kobe, Japan.
Akiko
A
Yokoi
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Hajime
H
Takayasu
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Hiroomi
H
Okuyama
Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
Koji
K
Fukumoto
Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
Naoto
N
Urushihara
Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan.
Tomoaki
T
Taguchi
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Noriaki
N
Usui
D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000209:etiology; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D006352:Heart Ventricles / Q000002:abnormalities / Q000000981:diagnostic imaging; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities / Q000000981:diagnostic imaging*; D008297:Male; D011379:Prognosis; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology
Congenital diaphragmatic hernia; Echocardiography; Left heart hypoplasia; Persistent pulmonary hypertension