1. Right Congenital Diaphragmatic Hernias: Is There a Correlation between Prenatal Lung Volume and Postnatal Survival, as in Isolated Left Diaphragmatic Hernias?
- Author
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Mark P. Johnson, William H. Peranteau, J. Christopher Edgar, Suzanne D. Iyoob, Ann M. Johnson, N. Scott Adzick, Teresa Victoria, Alan W. Flake, Enrico Danzer, Holly Hedrick, Emily A. Partridge, Edward R. Oliver, and Beverly G. Coleman
- Subjects
Adult ,Male ,Fetal magnetic resonance imaging ,Embryology ,medicine.medical_specialty ,Cephalometry ,medicine.medical_treatment ,Diaphragmatic breathing ,Gestational Age ,Ultrasonography, Prenatal ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Lung volumes ,Lung ,Retrospective Studies ,Philadelphia ,030219 obstetrics & reproductive medicine ,Fetal surgery ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Congenital diaphragmatic hernia ,Prenatal imaging ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Treatment Outcome ,Liver ,Pediatrics, Perinatology and Child Health ,Female ,Hernias, Diaphragmatic, Congenital ,Lung Volume Measurements ,business - Abstract
Objectives: 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%. Conclusion: 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.
- Published
- 2017