Fetal left-sided cardiac structural dimensions in left-sided congenital diaphragmatic hernia - association with severity and impact on postnatal outcomes

Prenat Diagn. 2017 May;37(5):502-509. doi: 10.1002/pd.5045. Epub 2017 Apr 27.


Objectives: Fetuses with congenital diaphragmatic hernia (CDH) demonstrate varying degrees of left heart hypoplasia. Our study assesses the relationship between fetal left-sided cardiac structural dimensions, lung size, percentage liver herniation, lung-to-head ratio, postnatal left-sided cardiac structural dimensions, and postnatal outcomes.

Methods: We performed a retrospective cohort study of fetuses with left-sided CDH who had prenatal echocardiographic, ultrasound, and magnetic resonance imaging examinations at our institution between January 2007 and March 2015. Postnatal outcomes assessed include use of inhaled nitric oxide (iNO), use of extracorporeal membrane oxygenation, and death.

Results: Fifty-two fetuses with isolated left-sided CDH were included. Multivariate logistic regression models indicated that smaller fetal aortic valve z-score was associated with postnatal use of iNO (p = 0.03). Fetal mitral valve z-score correlated with lung-to-head ratio (p = 0.04), postnatal mitral valve z-score correlated with percent liver herniation (p = 0.03), and postnatal left ventricular end-diastolic dimension z-score correlated with liver herniation <20% (p = 0.04).

Conclusion: We identified associations between smaller fetal left-sided cardiac structural dimensions and classic CDH indices. Smaller aortic valve z-score was associated with iNO use; however, left heart dimensions showed no association with extracorporeal membrane oxygenation or mortality. Further study into the impact of left-sided hypoplasia on outcomes in CDH is worthy of evaluation in a larger, prospective study. © 2017 John Wiley & Sons, Ltd.

MeSH terms

  • Female
  • Fetal Heart / diagnostic imaging*
  • Fetal Heart / pathology*
  • Fetus / diagnostic imaging*
  • Fetus / pathology
  • Gestational Age
  • Hernias, Diaphragmatic, Congenital / complications
  • Hernias, Diaphragmatic, Congenital / diagnosis*
  • Hernias, Diaphragmatic, Congenital / pathology
  • Humans
  • Hypoplastic Left Heart Syndrome / complications
  • Hypoplastic Left Heart Syndrome / diagnosis*
  • Hypoplastic Left Heart Syndrome / pathology
  • Male
  • Organ Size
  • Pregnancy
  • Pregnancy Outcome*
  • Retrospective Studies
  • Severity of Illness Index
  • Ultrasonography, Prenatal