Top

Published in:

01-12-2008 | Original Article

Significance of pulmonary artery size and blood flow as a predictor of outcome in congenital diaphragmatic hernia

Authors: Tadaharu Okazaki, Manabu Okawada, Satoko Shiyanagi, Hiromichi Shoji, Toshiaki Shimizu, Toshitaka Tanaka, Satoru Takeda, Kazunari Kawashima, Geoffrey J. Lane, Atsuyuki Yamataka

Published in: Pediatric Surgery International | Issue 12/2008

Abstract

Aim

To determine if pulmonary artery size and blood flow have prognostic value in congenital diaphragmatic hernia (CDH).

Methods

Twenty-eight consecutive left-sided CDH patients treated according to a standard protocol with high frequency oscillatory ventilation (HFOV) + nitric oxide (NO) had right and left pulmonary artery (RPA, LPA) diameters, LPA/RPA diameter (L/R) ratios, and PA blood flows examined by echocardiography (EC) on days 0, 2, and 5 after birth and compared prospectively.

Results

Twenty-two patients (78.6%) survived. Of these, 15 required NO (NO-s), and seven did not (non-NO-s). All six patients that died required NO (NO-d). RPA in the NO-d group was significantly smaller than in the NO-s or non-NO-s groups on day 0 (2.90 ± 0.41 vs. 3.40 ± 0.49 or 4.01 ± 0.43; P < 0.01, respectively). LPA in the NO-d group was significantly smaller than in the non-NO-s on day 0 (2.13 ± 0.45 vs. 3.39 ± 0.34; P < 0.01). L/R ratios in NO subjects were significantly smaller (NO-s 0.74 ± 0.11; NO-d 0.73 ± 0.11) than in non-NO-s subjects (0.84 ± 0.03) on day 0 (P < 0.01). PA diameters and L/R ratios did not change significantly from day 0 to day 5 in all three groups. There was LPA flow on day 0 in all non-NO-s subjects, but none in all NO subjects. In the NO-s group, LPA flow was confirmed in 87% (13/15) on day 2 and in 100% on day 5, however, there was no LPA flow from day 0 to day 5 in any of the NO-d group.

Conclusion

Our data indicate that PA diameters on day 0 and LPA flow are strongly prognostic in left-sided CDH and L/R ratio would appear to be a simple highly reliable indicator of the necessity for NO therapy.

Molenaar JC, Bos AP, Hazebroek FWJ, Tibboel D (1991) Congenital diaphragmatic hernia, what defect? J Pediatr Surg 26:248–254PubMedCrossRef

The congenital diaphragmatic hernia study group (2001) Estimating disease severity of congenital diaphragmatic hernia in the first 5 minutes of life. J Pediatr Surg 36:141–145CrossRef

The congenital diaphragmatic hernia study group (2006) Treatment evolution in high-risk congenital diaphragmatic hernia—ten years’ experience with diaphragmatic agenesis. Ann Surg 244:505–513

Usui N, Okuyama H, Sawai T, Kamiyama M, Kamata S, Fukuzawa M (2007) Relationship between L/T ratio and LHR in the prenatal assessment of pulmonary hypoplasia in congenital diaphragmatic hernia. Pediatr Surg Int 23:971–976PubMedCrossRef

Kitano Y, Nakagawa S, Kuroda T, Honna T, Itoh Y, Nakamura T, Morikawa N, Shimizu N, Kashima K, Hayashi S, Sago H (2005) Liver position in fetal congenital diaphragmatic hernia retains a prognostic value in the era of lung-protective strategy. J Pediatr Surg 40:1827–1832PubMedCrossRef

Sokol J, Bohn D, Lacro RV, Ryan G, Stephens D, Rabinovich M (2002) Fetal pulmonary artery diameters and their association with lung hypoplasia and postnatal outcome in congenital diaphragmatic hernia. Am J Obstet Gynecol 186:1085–1090PubMedCrossRef

Sokol J, Shimizu N, Bohn D, Doherty D, Ryan G, Hornberger LK (2006) Fetal pulmonary artery diameter measurements as a predictor of morbidity in antenatally diagnosed congenital diaphragmatic hernia: a prospective study. Am J Obstet Gynecol 195:470–477PubMedCrossRef

Hasegawa S, Kohno S, Sugiyama T (1994) Usefulness of echocardiographic measurement of bilateral pulmonary artery dimensions in congenital diaphragmatic hernia. J Pediatr Surg 29:622–624PubMedCrossRef

Okazaki T, Kohno S, Hasegawa S, Urushihara N, Yoshida A, Kawano S, Saito A, Tanaka Y (2003) Congenital diaphragmatic hernia: efficacy of ultrasound examination in its management. Pediatr Surg Int 19:176–179PubMed

10.

Ochikubo CG, Waffarn F, Turbow R, Kanakriyeh M (1997) Echocardiographic evidence of improved hemodynamics during inhaled nitric oxide therapy for persistent pulmonary hypertension of the newborn. Pediatr Cardiol 18:282–287PubMedCrossRef

11.

Dillon PW, Cilley RE, Mauger D, Zachary C, Meier A (2004) The relationship of pulmonary artery pressure and survival in congenital diaphragmatic hernia. J Pediatr Surg 39:307–312PubMedCrossRef

12.

Okawada M, Okazaki T, Yamataka A, Yanai T, Kato Y, Kobayashi H, Lane GJ, Miyano T (2006) Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases. Pediatr Surg Int 22:925–930PubMedCrossRef

13.

O’Tool SJ, Karamanoukian HL, Glick PL (1996) Cardiopulmonary consequences of congenital diaphragmatic hernia. J Pedinatol 16:34–39

14.

Buss M, Williams G, Dilley A, Jones O (2006) Prevention of heart failure in the management of congenital diaphragmatic hernia by maintaining ductal patency. A case report. J Pediatr Surg 41:E9–E11PubMedCrossRef

15.

Geggel PL, Murphy JD, Langleben D, Crone RK, Vacanti JP, Reid LA (1985) Congenital diaphragmatic hernia: arterial structural changes and persistent pulmonary hypertension after surgical repair. J Pediatr 107:457–464PubMedCrossRef

16.

Taira Y, Yamataka T, Miyazaki E, Puri P (1998) Comparison of the pulmonary vasculature in newborns and stillborns with congenital diaphragmatic hernia. Pediatr Surg Int 14:30–35PubMedCrossRef

17.

Sokol J, Bohn D, Lacro RV, Ryan G, Stephens D, Rabinovitch M (2002) Fetal pulmonary artery diameters and their association with lung hypoplasia and postnatal outcome in congenital diaphragmatic hernia. Am J Obstet Gynecol 186:1085–1090PubMedCrossRef

18.

Sokol J, Shimizu N, Bohn D, Dohrty D, Ryan G, Hornberger LK (2006) Fetal pulmonary artery diameter measurements as a predictor of morbidity in antenatally diagnosed congenital diaphragmatic hernia: a prospective study. Am J Obstet Gynecol 195:470–477PubMedCrossRef

19.

Walsh MC, Stock EK (2001) Persistent pulmonary hypertension of the newborn. Rational therapy based on pathophysiology. Clin Peinatol 28:609–627CrossRef

20.

Okuyama H, Kubota A, Oue T, Kuroda S, Ikegami R, Kamiyama M, Kitayama Y, Yagi M (2002) Inhaled nitric oxide with early surgery improves the outcome of antenatally diagnosed congenital diaphragmatic hernia. J Pediatr Surg 37:1188–1190PubMedCrossRef

21.

Christou H, Marter J, Wessel DL et al (2000) Inhaled nitric oxide reduces the need for ECMO in infants with persistent pulmonary hypertension of the newborn. Crit Care Med 28:3722–3727PubMedCrossRef

22.

The national inhaled nitric oxide study group (1997) Inhaled nitric oxide and hypoxic respiratory failure in infants with congenital diaphragmatic hernia. Pediatrics 99:838–845CrossRef

23.

Okazaki T, Sharma HS, McCune SK, Tibboel D (1998) Pulmonary vascular balance in congenital diaphragmatic hernia: enhanced endothelin-1 gene expression as a possible cause of pulmonary vasoconstriction. J Pediatr Surg 33:81–84PubMedCrossRef

24.

Kobayashi H, Puri P (1994) Plasma endothelin levels in congenital diaphragmatic hernia. J Pediatr Surg 29:1258–1261PubMedCrossRef

25.

Shiyanagi S, Okazaki T, Shoji H, Shimizu T, Tanaka T, Takeda S, Lane GJ, Yamataka A (2008) Management of pulmonary hypertension in congenital diaphragmatic hernia: nitric oxide with prostaglandin-E1 vs. nitric oxide alone. Pediatr Surg Int (in press)

Title: Significance of pulmonary artery size and blood flow as a predictor of outcome in congenital diaphragmatic hernia
Authors: Tadaharu Okazaki
Manabu Okawada
Satoko Shiyanagi
Hiromichi Shoji
Toshiaki Shimizu
Toshitaka Tanaka
Satoru Takeda
Kazunari Kawashima
Geoffrey J. Lane
Atsuyuki Yamataka
Publication date: 01-12-2008
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 12/2008
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-008-2266-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Significance of pulmonary artery size and blood flow as a predictor of outcome in congenital diaphragmatic hernia

Abstract

Aim

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aim

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2008

Universal expression of cell adhesion molecule NCAM in neuroblastoma in contrast to L1: implications for different roles in tumor biology of neuroblastoma?

In vitro and in vivo evaluation of photodynamic techniques for the experimental treatment of human hepatoblastoma and neuroblastoma: preliminary results

Brain malformations in the sheep model of myelomeningocele are similar to those found in human disease: preliminary report

Xenogeneic islet transplantation of microencapsulated porcine islets for therapy of type I diabetes: long-term normoglycemia in STZ-diabetic rats without immunosuppression

Vagal neural crest provides inhibitory neurotransmission to the chick embryo cloaca

Carbon dioxide does not affect the methylation status of prognostic important oncogenes Rassf1A and DCR2 in neuroblastoma cells