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Isolated left-sided congenital diaphragmatic hernia: cardiac axis and displacement before fetal viability has no role in predicting postnatal outcome

Isolated left-sided congenital diaphragmatic hernia: cardiac axis and displacement before fetal viability has no role in predicting postnatal outcome
Isolated left-sided congenital diaphragmatic hernia: cardiac axis and displacement before fetal viability has no role in predicting postnatal outcome
OBJECTIVES: The purpose of this retrospective study was to determine whether objective assessment of cardiac shifting on two-dimensional ultrasonography can predict postnatal outcome in fetuses with isolated left-sided congenital diaphragmatic hernia (CDH). MATERIALS AND METHODS: Still images at the level of the four-chamber view were obtained in 23 fetuses with left-sided CDH. A group of 12 fetuses (3 non-survivors and 9 survivors) were examined at two periods, between 20 and 30 weeks and between 31 and 40 weeks. A further 11 fetuses (2 non-survivors and 9 survivors) were examined between 31 and 40 weeks. Fetal heart axis and position were determined manually and associated with postnatal outcome. RESULTS: The cardiac axis remained constant in the 9 survivors (15.5 +/- 3.2 versus 17.2 +/- 3.3, p = 0.71) and 3 non-survivors (19.0 +/- 11.5 versus 18.5 +/- 11.8, p = 0.97). There was no statistical difference between the 9 survivors and 3 non-survivors at the two periods. Cardiac displacement remained constant in the 9 survivors (0.2 +/- 0.02 versus 0.2 +/- 0.02, p = 0.32) but increased significantly in the 3 non-survivors (0.2 +/- 0.04 versus 0.4 +/- 0.02, p = 0.015). The difference between survivors and non-survivors was statistically significant between the18 survivors and 5 non-survivors examined between 31 and 40 weeks of gestation (0.2 +/- 0.02 versus 0.4 +/- 0.02, p = 0.037). CONCLUSION: This study does not support the hypothesis that objective assessment of mediastinal shift in fetuses with left-sided CDH has a role in predicting postnatal outcome before fetal viability, which is when it would be more useful for counseling patients regarding whether to continue with the pregnancy or to opt for termination.
congenital diaphragmatic hernia, prenatal diagnosis, echocardiography
0197-3851
322-326
Kalache, Karim D.
fc3d1666-551d-4dce-845c-710c5908d726
Mkhitaryan, Monika
edc2c10d-2bbf-4006-9123-8943f24fedbf
Bamberg, Christian
8ea27a63-3fff-496e-9420-4d40c3cdcea2
Roehr, Charles Christoph
62479d02-50cc-4495-a19f-85652e88a10e
Wauer, Roland
68982769-4106-4a0a-ac76-b62482e15118
Mau, Harald
6bacf139-3685-4039-9c32-c137b316319f
Bollmann, Rainer
394e531a-fd07-48d6-a994-448b02b67a96
Kalache, Karim D.
fc3d1666-551d-4dce-845c-710c5908d726
Mkhitaryan, Monika
edc2c10d-2bbf-4006-9123-8943f24fedbf
Bamberg, Christian
8ea27a63-3fff-496e-9420-4d40c3cdcea2
Roehr, Charles Christoph
62479d02-50cc-4495-a19f-85652e88a10e
Wauer, Roland
68982769-4106-4a0a-ac76-b62482e15118
Mau, Harald
6bacf139-3685-4039-9c32-c137b316319f
Bollmann, Rainer
394e531a-fd07-48d6-a994-448b02b67a96

Kalache, Karim D., Mkhitaryan, Monika, Bamberg, Christian, Roehr, Charles Christoph, Wauer, Roland, Mau, Harald and Bollmann, Rainer (2007) Isolated left-sided congenital diaphragmatic hernia: cardiac axis and displacement before fetal viability has no role in predicting postnatal outcome. Prenatal Diagnosis, 27 (4), 322-326. (doi:10.1002/pd.1669).

Record type: Article

Abstract

OBJECTIVES: The purpose of this retrospective study was to determine whether objective assessment of cardiac shifting on two-dimensional ultrasonography can predict postnatal outcome in fetuses with isolated left-sided congenital diaphragmatic hernia (CDH). MATERIALS AND METHODS: Still images at the level of the four-chamber view were obtained in 23 fetuses with left-sided CDH. A group of 12 fetuses (3 non-survivors and 9 survivors) were examined at two periods, between 20 and 30 weeks and between 31 and 40 weeks. A further 11 fetuses (2 non-survivors and 9 survivors) were examined between 31 and 40 weeks. Fetal heart axis and position were determined manually and associated with postnatal outcome. RESULTS: The cardiac axis remained constant in the 9 survivors (15.5 +/- 3.2 versus 17.2 +/- 3.3, p = 0.71) and 3 non-survivors (19.0 +/- 11.5 versus 18.5 +/- 11.8, p = 0.97). There was no statistical difference between the 9 survivors and 3 non-survivors at the two periods. Cardiac displacement remained constant in the 9 survivors (0.2 +/- 0.02 versus 0.2 +/- 0.02, p = 0.32) but increased significantly in the 3 non-survivors (0.2 +/- 0.04 versus 0.4 +/- 0.02, p = 0.015). The difference between survivors and non-survivors was statistically significant between the18 survivors and 5 non-survivors examined between 31 and 40 weeks of gestation (0.2 +/- 0.02 versus 0.4 +/- 0.02, p = 0.037). CONCLUSION: This study does not support the hypothesis that objective assessment of mediastinal shift in fetuses with left-sided CDH has a role in predicting postnatal outcome before fetal viability, which is when it would be more useful for counseling patients regarding whether to continue with the pregnancy or to opt for termination.

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More information

Published date: April 2007
Keywords: congenital diaphragmatic hernia, prenatal diagnosis, echocardiography

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Local EPrints ID: 61268
URI: http://eprints.soton.ac.uk/id/eprint/61268
ISSN: 0197-3851
PURE UUID: 79a69c4e-a8cb-4ac8-ad74-d6904a687f10

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Date deposited: 29 Sep 2008
Last modified: 15 Mar 2024 11:25

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Contributors

Author: Karim D. Kalache
Author: Monika Mkhitaryan
Author: Christian Bamberg
Author: Charles Christoph Roehr
Author: Roland Wauer
Author: Harald Mau
Author: Rainer Bollmann

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