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

Pediatric Surgery International - Tập 24 - Trang 1369-1373 - 2008
Tadaharu Okazaki1, Manabu Okawada1, Satoko Shiyanagi1, Hiromichi Shoji2, Toshiaki Shimizu2, Toshitaka Tanaka3, Satoru Takeda3, Kazunari Kawashima4, Geoffrey J. Lane1, Atsuyuki Yamataka1
1Department of Pediatric Surgery, Juntendo University School of Medicine, Bunkyo-Ku, Japan
2Department of Pediatrics, Juntendo University School of Medicine, Bunkyo-ku, Japan
3Departments of Obstetrics and Gynecology, Juntendo University School of Medicine, Bunkyo-Ku, Japan
4Department of Obstetrics, Gonohashi Ladies’ Clinic, Koto-ku, Tokyo, Japan

Tóm tắt

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

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Pediatric Surgery International

Tập 24

1369-1373

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