Matthew Wong1, Janette Reyes2, Eveline Lapidus-Krol1, Monping Chiang1, Tilman Humpl2, Malikah Al-Faraj3, Greg Ryan3, Priscilla P L Chiu4. 1. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. 2. Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. 3. Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. 4. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Electronic address: priscilla.chiu@sickkids.ca.
Abstract
Prenatal observed/expected lung-to-head ratio (O/E LHR) by ultrasound correlates with postnatal mortality for congenital diaphragmatic hernia (CDH) patients. The aim of this study is to determine if O/E LHR correlates with pulmonary hypertension (PH) outcomes for CDH patients. METHODS: A single center retrospective chart review was performed for CDH neonates from January 1, 2006, to December 31, 2015, (REB #1000053124) to include prenatal O/E LHR, liver position, first arterial blood gas, repair type, echocardiogram (ECHO), and lung perfusion scan (LPS) results up to 5years of age. RESULTS: Of 153 newborns, 123 survived (80.4%), 58 (37.9%) had prenatal O/E LHR, and 42 (27.5%) had postnatal ECHO results. High mortality risk neonates (O/E LHR ≤45%) correlated with higher right ventricular systolic pressure (RVsp) at birth. Generally PH resolved by age 5years. LPS results did not change over time (p>0.05) regardless of initial PH severity, suggesting that PH resolution did not correlate with increased ipsilateral lung perfusion to offload the right ventricle. CONCLUSION: Prenatal prognostic markers correlated with initial PH severity for CDH newborns, but PH resolved over time despite fixed perfusion bias to the lungs. These results suggest favorable PH outcomes for CDH patients who survive beyond infancy. TYPE OF STUDY: Retrospective Cohort Study. LEVEL OF EVIDENCE: 3b.
Prenatal observed/expected lung-to-head ratio (O/E LHR) by ultrasound correlates with postnatal mortality for congenital diaphragmatic hernia (CDH) patients. The aim of this study is to determine if O/E LHR correlates with pulmonary hypertension (PH) outcomes for CDHpatients. METHODS: A single center retrospective chart review was performed for CDH neonates from January 1, 2006, to December 31, 2015, (REB #1000053124) to include prenatal O/E LHR, liver position, first arterial blood gas, repair type, echocardiogram (ECHO), and lung perfusion scan (LPS) results up to 5years of age. RESULTS: Of 153 newborns, 123 survived (80.4%), 58 (37.9%) had prenatal O/E LHR, and 42 (27.5%) had postnatal ECHO results. High mortality risk neonates (O/E LHR ≤45%) correlated with higher right ventricular systolic pressure (RVsp) at birth. Generally PH resolved by age 5years. LPS results did not change over time (p>0.05) regardless of initial PH severity, suggesting that PH resolution did not correlate with increased ipsilateral lung perfusion to offload the right ventricle. CONCLUSION: Prenatal prognostic markers correlated with initial PH severity for CDH newborns, but PH resolved over time despite fixed perfusion bias to the lungs. These results suggest favorable PH outcomes for CDHpatients who survive beyond infancy. TYPE OF STUDY: Retrospective Cohort Study. LEVEL OF EVIDENCE: 3b.
Authors: Augusto Zani; Wendy K Chung; Jan Deprest; Matthew T Harting; Tim Jancelewicz; Shaun M Kunisaki; Neil Patel; Lina Antounians; Pramod S Puligandla; Richard Keijzer Journal: Nat Rev Dis Primers Date: 2022-06-01 Impact factor: 52.329
Authors: Jane E Gross; Michael Y McCown; Caroline Okorie; Lara C Bishay; Fei J Dy; Jordan S Rettig; Christopher D Baker; John R Balmes; Andrew T Barber; Sourav K Bose; Alicia Casey; Stephen M M Hawkins; Alexandra Kass; Garrett Keim; Nadine Mokhallati; Gregory Montgomery; William H Peranteau; Ryan Serrano; Timothy J Vece; Nadir Yehya; Debra Boyer; Margaret M Hayes Journal: ATS Sch Date: 2020-12-30