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Pediatric Cardiology

, Volume 39, Issue 5, pp 993–1000 | Cite as

Diminished Cardiac Performance and Left Ventricular Dimensions in Neonates with Congenital Diaphragmatic Hernia

  • Gabriel Altit
  • Shazia Bhombal
  • Krisa Van Meurs
  • Theresa A. Tacy
Original Article

Abstract

Introduction

Newborns with congenital diaphragmatic hernia (CDH) have varying degrees of pulmonary hypoplasia and pulmonary hypertension (PH), and there is limited evidence that cardiac dysfunction is present. We sought to study early neonatal biventricular function and performance in these patients by reviewing early post-natal echocardiography (ECHO) measurements and comparing them to normal term newborns.

Methods

Retrospective case–control study reviewing clinical and ECHO data on term newborns with CDH and normal controls born between 2009 and 2016. Patients were excluded if major anomalies, genetic syndromes, or no ECHO available. PH was assessed by ductal shunting and tricuspid regurgitant jet velocity. Speckle-tracking echocardiography was used to assess myocardial deformation using velocity vector imaging.

Results

Forty-four patients with CDH and 18 age-matched controls were analyzed. Pulmonary pressures were significantly higher in the CDH cohort (systolic pulmonary arterial pressure to systolic blood pressure of 103 ± 13 vs. 78 ± 29%, p = 0.0001). CDH patients had decreased RV fractional area change (FAC − 28.6 ± 11.1 vs. 36.2 ± 9.6%, p = 0.02), tricuspid annular plane of systolic excursion (TAPSE—5.6 ± 1.6 vs. 8.6 ± 1.6 mm, p = 0.0001), and RV outflow tract stroke distance (8.6 ± 2.7 vs. 14.0 ± 4.5 cm, p = 0.0001) compared with controls. The left ventricular (LV) ejection fraction was similar in both groups, but CDH patients had a decreased LV end-diastolic volume by Simpson’s rule (2.7 ± 1.0 vs. 5.0 ± 1.8 mL, p = 0.0001) and LVOT stroke distance (9.7 ± 3.4 vs. 12.6 ± 3.6 cm, p = 0.004). Biventricular global longitudinal strain (GLS) was markedly decreased in the CDH population compared to controls (RV-GLS: − 9.0 ± 5.3 vs. − 19.5 ± 1.4%, p = 0.0001; LV GLS: − 13.2 ± 5.8 vs. − 20.8 ± 3.5%, p = 0.0001).

Conclusion

CDH newborns have evidence of biventricular dysfunction and decreased cardiac output. Abnormal function may be a factor in the non-response to pulmonary arterial vasodilators in CDH patients. A two-pronged management strategy aimed at improving cardiac function, as well as reducing pulmonary artery pressure in CDH newborns, may be warranted.

Keywords

Speckle-tracking echocardiography Congenital diaphragmatic hernia Neonatal cardiac function Pulmonary hypertension Strain analysis Velocity vector imaging 

Abbreviations

BP

Blood pressure

CDH

Congenital diaphragmatic hernia

DICOM

Digital imaging and communications in medicine format

EDSR

Early diastolic strain rate

EF

Ejection fraction

EDV

End-diastolic volume

ECMO

Extracorporeal membrane oxygenation

FAC

Fractional area change

GLS

Global longitudinal strain

GLSR

Global longitudinal strain rate

LV

Left ventricle

EI

Eccentricity index

LVOT

Left ventricular outflow tract

MPA

Main pulmonary artery

PDA

Patent ductus arteriosus

PAP

Pulmonary artery pressure

RV

Right ventricle

RVOT

Right ventricular outflow tract

STE

Speckle-tracking echocardiography

SD

Standard deviation

TAPSE

Tricuspid annular plane systolic excursion

TR

Tricuspid regurgitant jet velocity

VTI

Velocity time integral

VVI

Velocity vector imaging

Notes

Compliance with Ethical Standards

Conflict of interest

We have no conflicts of interest related to the content of this study. Gabriel Altit is the author that wrote the first draft. There was no payment, grant, or honorarium given to anyone to produce the manuscript.

Ethical Approval

This study was approved by the institutional review board of Stanford University (protocol—IRB-39501).

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Neonatology, Department of PediatricsMcGill University – Montreal Children’s HospitalMontrealCanada
  2. 2.Division of Neonatal and Developmental Medicine, Department of PediatricsStanford University School of MedicineStanfordUSA
  3. 3.Neonatal ECMO ProgramLucile Packard Children’s Hospital at StanfordStanfordUSA
  4. 4.Division of Cardiology, Echocardiography Laboratory, Department of PediatricsStanford University - Lucile Packard Children’s HospitalStanfordUSA

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