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Implications of Atrial-Level Shunting by Echocardiography in Newborns with Congenital Diaphragmatic Hernia
- Source :
- The Journal of pediatrics. 219
- Publication Year :
- 2019
-
Abstract
- Objective To determine whether postnatal echocardiographic indices of left ventricular (LV) size and function are associated with atrial-level shunt direction and investigate whether a relationship exists between LV function and LV size in patients with congenital diaphragmatic hernia (CDH). Study design This was a single-center retrospective study of 51 neonates with CDH evaluated at Children's Hospital Colorado. Initial postnatal echocardiograms were analyzed for cardiac dimensions, valvar integrity, cardiac time intervals, and biventricular function. Comparisons were made between neonates with left-to-right vs right-to-left atrial-level shunting, as well as between those with decreased (ejection fraction Results The majority (82.4%) of infants with CDH had a left-to-right atrial-level shunt, and 84.3% had systemic or suprasystemic pulmonary artery pressure. Decreased LV function was demonstrated in 37.2% and was associated with smaller LV volumes and worse outcomes, including the need for extracorporeal membrane oxygenation (ECMO) and survival. Conclusions Left-to-right atrial-level shunting is common in neonates with severe CDH, even in the presence of suprasystemic pulmonary artery pressure. LV dysfunction correlates with decreased LV volumes and is associated with adverse neonatal outcomes, including increased need for ECMO and decreased survival.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Heart Ventricles
Hypertension, Pulmonary
Diaphragmatic breathing
Ventricular Function, Left
Internal medicine
medicine.artery
medicine
Extracorporeal membrane oxygenation
Humans
Heart Atria
Retrospective Studies
Ejection fraction
business.industry
Infant, Newborn
Congenital diaphragmatic hernia
Retrospective cohort study
medicine.disease
Shunting
Echocardiography
Pediatrics, Perinatology and Child Health
Pulmonary artery
cardiovascular system
Cardiology
Female
business
Hernias, Diaphragmatic, Congenital
Shunt (electrical)
Subjects
Details
- ISSN :
- 10976833
- Volume :
- 219
- Database :
- OpenAIRE
- Journal :
- The Journal of pediatrics
- Accession number :
- edsair.doi.dedup.....f89e99b28be6a1691e2f0814fceb4004