Ventricular function in congenital diaphragmatic hernia: a systematic review and meta-analysis

Exploring new perspectives on congenital diaphragmatic hernia: A comprehensive review

Congenital diaphragmatic hernia (CDH) represents a developmental anomaly that profoundly impacts the embryonic development of both the respiratory and cardiovascular systems. Understanding the influences of developmental defects, their origins, and clinical consequences is of paramount importance for further research and the advancement of therapeutic strategies for this condition. In recent years, groundbreaking studies in the fields of metabolomics and genomics have significantly expanded our knowledge regarding the pathogenic mechanisms of CDH. These investigations introduce novel diagnostic and therapeutic avenues. CDH implies a scarcity of available information within this domain. Consequently, a comprehensive literature review has been undertaken to synthesize existing data, providing invaluable insights into this rare disease. Improved comprehension of the molecular underpinnings of CDH has the potential to refine diagnostic precision and therapeutic interventions, thus potentially enhancing clinical outcomes for CDH patients. The identification of potential biomarkers assumes paramount significance for early disease detection and risk assessment in CDH, facilitating prompt recognition and the implementation of appropriate interventions. The process of translating research findings into clinical practice is significantly facilitated by an exhaustive literature review. It serves as a pivotal step, enabling the integration of novel, more effective diagnostic and therapeutic modalities into the management of CDH patients.

Fetal MRI-Based Mediastinal Shift Angle (MSA) and Percentage Area of Left Ventricle (pALV) as Prognostic Parameters for Congenital Diaphragmatic Hernia

OBJECTIVE

Fetal magnetic resonance imaging (MRI) is broadly used as a method for assessing prognosis in congenital diaphragmatic hernia (CDH). In addition to the extent of lung hypoplasia, determined by measuring the lung volume, cardiac impairment due to pulmonary hypertension and left cardiac hypoplasia is decisive for the prognosis. The percentage area of left ventricle (pALV) describes the percentage of the inner area of the left ventricle in relation to the total area, whereas the mediastinal shift angle (MSA) quantifies the extent of cardiac displacement. The prognostic value of pALV and MSA should be evaluated in terms of survival, the need for extracorporeal membrane oxygenation (ECMO) therapy, and the development of chronic lung disease (CLD).

METHODS

In a total of 122 fetal MRIs, the MSA and pALV were measured retrospectively and complete outcome parameters were determined regarding survival for all 122 subjects, regarding ECMO therapy in 109 cases and about the development of CLD in 78 cases. The prognostic value regarding the endpoints was evaluated using logistic regression and ROC analysis.

RESULTS

The MSA was significantly higher in children who received ECMO therapy (p = 0.0054), as well as in children who developed CLD (p = 0.0018). ROC analysis showed an AUC of 0.68 for ECMO requirement and 0.77 with respect to CLD development. The pALV showed a tendency towards higher levels in children who received ECMO therapy (p = 0.0824). The MSA and the pALV had no significant effect on survival (MSA: p = 0.4293, AUC = 0.56; pALV: p = 0.1134, AUC = 0.57).

CONCLUSIONS

The MSA determined in fetal MRI is a suitable prognostic parameter for ECMO requirement and CLD development in CDH patients and can possibly be used as a supplement to the established parameters.

Failure to Normalize Biventricular Function Is Associated with Extracorporeal Membrane Oxygenation Use in Neonates with Congenital Diaphragmatic Hernia

We examined postnatal echocardiograms for 62 infants with congenital diaphragmatic hernia born from 2014 through 2020. Left and right ventricular dysfunction on D0 were sensitive, whereas persistent dysfunction on D2 was specific for extracorporeal membrane oxygenation requirement. Biventricular dysfunction had the strongest association with extracorporeal membrane oxygenation. Serial echocardiography may inform prognosis in congenital diaphragmatic hernia.

A potential cause of left ventricular dysfunction after surgery in neonates with low-risk congenital diaphragmatic hernia: high-tension repair

BACKGROUND

Congenital diaphragmatic hernia (CDH) is a serious congenital malformation. Given the focus on improving survival in patients with "high-risk" CDH, it is possible that risk factors for low-risk patient with CDH may not be a concern. Left heart failure leads to adverse postoperative outcomes, including the need for extracorporeal membrane oxygenation (ECMO). The purpose of this study was to explore the causes of postoperative left heart failure in the low-risk group.

METHODS

A retrospective study was conducted on newborns with congenital diaphragmatic hernia who were surgically treated in our hospital from January 2018 to March 2022. Children at low risk were divided into three groups according to the intraoperative repair conditions. Group A was defined as grade A defects repaired by direct suture. Group B was defined as a grade B defect repaired by mesh. Group C was a grade B defect repaired by high-tension suture. The age, gender, weight, perioperative echocardiography, and follow-up of the patients were statistically analyzed. The risk factors of left ventricular dysfunction after surgery in neonates with low-risk congenital diaphragmatic hernia were analyzed.

RESULTS

A total of 52 low-risk children were included in the study. For children in the low-risk group, there was no significant difference between the low-tension repair group and the high-tension repair group in terms of operation time, thoracic tube drainage time, hospital stay, and long-term survival rate. Group A and group B showed good left ventricular function, while group C showed more decreased left ventricular EF and LVFS (LVEF 54.06 ± 10.28, LVFS 26.94 ± 5.83, p < 0.001). On the comparison of measures of left ventricular size, the mean values of left ventricular end-diastolic diameters(LVDD) and left ventricular end-systolic diameters (LVDS) were significantly difference in group C. Univariate analysis showed that LHR, o/e LHR, operation time, and high-tension repair were the influencing factors of left ventricular dysfunction. Multivariate logistic regression analysis identified risk factors for high-tension repair. Severe left heart dysfunction occurred in 2 patients with ECMO requirement in the high-tension repair group, although the difference was not significant.

CONCLUSIONS

High-tension repair is a potential cause of left ventricular dysfunction in neonates with low-risk CDH.