P. E. Lau1, C. C. Style1, S. M. Cruz1, D. A. Castellanos2, T. C. Lee1, J. A. Kailin2, D. L. Cass1, C. Fernandes3, S. G. Keswani1, O. O. Olutoye1 1Baylor College Of Medicine,Michael E Debakey Department Of Surgery,Houston, TX, USA 2Texas Children’s Hospital,Cardiology/Pediatrics,Houston, TX, USA 3Texas Children’s Hospital,Neonatology/Pediatrics,Houston, TX, USA
Introduction: Congenital diaphragmatic hernia (CDH) has been associated with smaller left heart structures and aorta which are thought to result from extrinsic compression by the viscera in the left chest cavity or intrinsic hypoplasia. The purpose of this study was to evaluate the effect of visceral herniation on aortic dimensions in neonates with CDH.
Methods: A retrospective review of the medical records of neonates with CDH treated at a tertiary children’s hospital from January 2011 to December 2016 was performed. Prenatal ultrasounds and MRIs were used to assess defect sidedness, the severity CDH using the observed to expected lung-to-head ratio (O/E LHR), observed to expected total fetal lung volume (O/E-TFLV), and degree of visceral herniation using percent of liver herniation (%LH) into the chest cavity. Aortic measurements from transthoracic echocardiograms in the immediate post-natal period and following surgical CDH repair were reviewed and reported based on the deviation from normal values (z-scores).
Results: A total of 113 CDH neonates were identified (90 left and 23 right). The size of the aortic annulus, aortic root, transverse arch, aortic isthmus and aortic valve were significantly smaller in L-CDH compared to R-CDH neonates (Table 1). A paired t-test showed a significant increase in size of the aortic annulus, root, ascending aorta, transverse arch and aortic valve (Table 1) after surgical repair. There were no differences in aortic dimensions in right-sided CDH after repair. Using the Pearson’s correlation coefficient, there was no significant correlation between aortic dimensions and severity of visceral herniation as determined by %LH or with lung hypoplasia as determined by O/E-TFLV and O/E LHR.
Conclusion: Neonates with left-sided CDH have smaller thoracic aortas compared to those with right-sided CDH. There was no correlation between degree of aortic hypoplasia and severity of CDH. However, CDH repair is associated with a significant improvement of the aortic hypoplasia. This will aid in prenatal counseling of these patients.
