Wang Xueyao,Pan Weihua,Xie Wei,et al.Comparative study on clinical characteristics and prenatal heart structures of children with a prenatal diagnosis of left or right congenital diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,,20():825-831.[doi:10.12260/lcxewkzz.2021.09.005]
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Comparative study on clinical characteristics and prenatal heart structures of children with a prenatal diagnosis of left or right congenital diaphragmatic hernia

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第20卷 Number: 2021 09 Page: 825-831 Column: 专题·先天性膈疝诊疗新进展 Date of publication: 2021-09-25
Author(s):
Wang Xueyao1;  Pan Weihua1;  Xie Wei2;  Chen Sun3;  Tang Xiaoyu1;  Wang Jun1
1. Department of Pediatric Surgery, Affiliated Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;
2. Pediatric Intensive Care Unit, Affiliated Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;
3. Department of Pediatric Cardiology, Affiliated Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Keywords:
Prenatal Diagnosis/MT; Hernias;  Diaphragmatic;  Congenital/DI; Hernias;  Diaphragmatic;  Congenital/MO; Ultrasonography;  Prenatal; Heart/AH
CLC:
R655.6;R541
DOI:
10.12260/lcxewkzz.2021.09.005
Abstract:
Objective To compare the clinical features and fetal cardiovascular structures in children with a prenatal diagnosis of left/right congenital diaphragmatic hernia (CDH).Methods From April 2009 to December 2019, a retrospective review was conducted for 179 CDH children.All of them participated in the antenatal-intrapartum-postnatal all-through service mode.Children with a prenatal diagnosis of left CDH(LCDH) and right CDH(RCDH) were compared with regards to prenatal parameters, neonatal outcomes, operation-related parameters, clinical outcomes and cardiac structure parameters on fetal echocardiography (ECHO).Results The involved side was left (n=137, 77.7%) and right (n=40, 22.3%).A total of 123 CDH children survived with an overall survival rate of 68.7%.The mortality rate of RCDH was higher than that of LCDH(20.9% vs.45.0%, P=0.034).The incidence of preterm delivery was higher (P=0.024), pH value lower (P=0.001) and PaCO2 value higher (P=0.002) within 1 hour of admission in RCDH.The proportion of type B defect was greater in LCDH and type D defect predominated in RCDH.Significant inter-group difference existed in the proportion of each type (P=0.007).In 41 fetuses examined by fetal ECHO, left ventricular diameter z-score of LCDH fetus was smaller (P=0.009) and right/left ventricle diameter (RVd/LVd) higher (P=0.027).In LCDH fetuses, Vd/LVd of fetus with liver hernia was higher (P=0.027).Left pulmonary artery diameter z-score of LCDH was significantly smaller than that of RCDH (P<0.007).However, no significant difference existed in RCDH fetus.Conclusion In children with a prenatal diagnosis of RCDH, worse condition at delivery and larger size of diaphragm defect denote a lower survival rate.In LCDH fetuses, the structure of left heart is smaller than that of RCDH fetuses.Hepatic hernia may affect the structure of left heart.

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Memo

收稿日期:2021-07-26。
通讯作者:王俊,Email:wangjun@xinhua.com.cn

Last Update: 1900-01-01