Gloria Pelizzo1, Rossana Bussani2, Lorenzo Zandonà2, Ana Custrin2, Carlo Valerio Bellieni3, Annalisa De Silvestri4, Valeria Calcaterra5. 1. a Pediatric Surgery Unit , Fondazione IRCCS Policlinico S. Matteo and University of Pavia , Pavia , Italy. 2. b Institute of Pathologic Anatomy , University of Trieste , Trieste , Italy. 3. c Policlinico Le Scotte, Neonatal Intensive Care Unit , University of Siena, Siena , Italy. 4. d Fondazione IRCCS Policlinico San Matteo, Scientific Direction, Biometry & Clinical Epidemiology , Pavia , Italy. 5. e Pediatric Unit, University of Pavia and Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
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). CONCLUSION: Left ventricle immaturity seems to be a cardiac adaptive response of severe CDH in utero.
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). CONCLUSION: Left ventricle immaturity seems to be a cardiac adaptive response of severe CDH in utero.
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