Right Congenital Diaphragmatic Hernias: Is There a Correlation between Prenatal Lung Volume and Postnatal Survival, as in Isolated Left Diaphragmatic Hernias?
OBJECTIVE
Whereas left-sided congenital diaphragmatic hernias (L-CDH) have been extensively studied and their prognostic parameters delineated, right-sided hernias (R-CDH) have not. Published results remain inconclusive. The aim of this study is to evaluate if proven prognostic indicators of postnatal survival in the fetus with L-CDH apply to the fetus with R-CDH.


METHODS
Retrospective single-center study of R-CDH fetuses with available prenatal studies assessed for fetal lung volume by means of ultrasound-measured observed versus expected (O/E) lung area to head circumference (LHR) and magnetic resonance-calculated O/E total lung volume (TLV) in a 12-year time period. Percentage of herniated liver volume and postnatal use of extracorporeal membrane oxygenation (ECMO) were also evaluated.


RESULTS
In a cohort of 24 patients, O/E LHR, O/E TLV, percentage of herniated liver, and postnatal use of ECMO are not prognostic indicators of survival in the fetus with R-CDH. Cut-off values of O/E LHR of ≤45 or O/E TLV ≤25, known to select a population of severe cases for the L-CDH fetus, do not appear to extrapolate to the R-CDH fetus, as survival in both R-CDH groups is 60%.


CONCLUSIONS
The findings in this study suggest that L- and R-CDH appear to behave differently, and that factors that make L-CDH fatal (low O/E TLV and O/E LHR, high-volume herniated liver) may not apply to the fetus with R-CDH.
Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Teresa
T
Victoria
Enrico
E
Danzer
Edward R
ER
Oliver
J Christopher
JC
Edgar
Suzanne
S
Iyoob
Emily A
EA
Partridge
Ann M
AM
Johnson
William H
WH
Peranteau
Beverly G
BG
Coleman
Alan W
AW
Flake
Mark P
MP
Johnson
Holly H
HH
Hedrick
N Scott
NS
Adzick
D000328:Adult; D002508:Cephalometry; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D008099:Liver / Q000000981:diagnostic imaging; D008168:Lung / Q000000981:diagnostic imaging*; D008176:Lung Volume Measurements / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D055815:Young Adult
Congenital diaphragmatic hernia; Fetal endoscopic tracheal occlusion; Fetal lung volume measurement; Fetal magnetic resonance imaging; Fetal surgery; Prenatal imaging