Significance of pulmonary artery size and blood flow as a predictor of outcome in congenital diaphragmatic hernia
| Autor: | Tadaharu Okazaki, Atsuyuki Yamataka, Kazunari Kawashima, Geoffrey J. Lane, Satoru Takeda, Satoko Shiyanagi, Manabu Okawada, Hiromichi Shoji, Toshiaki Shimizu, Toshitaka Tanaka |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Pulmonary Circulation medicine.medical_specialty Hemodynamics Diaphragmatic breathing Pulmonary Artery Internal medicine medicine.artery Pediatric surgery medicine Humans Hernia Lung Hernia Diaphragmatic business.industry Infant Newborn Congenital diaphragmatic hernia General Medicine Blood flow Prognosis medicine.disease Surgery medicine.anatomical_structure Echocardiography Pediatrics Perinatology and Child Health Pulmonary artery Cardiology Female Respiratory System Abnormalities Hernias Diaphragmatic Congenital business Blood Flow Velocity |
| Zdroj: | Pediatric Surgery International. 24:1369-1373 |
| ISSN: | 1437-9813 0179-0358 |
| Popis: | 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; P0.01, 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; P0.01). 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 (P0.01). 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. |
| Databáze: | OpenAIRE |
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