Contribution of intrapulmonary artery Doppler to improve prediction of survival in fetuses with congenital diaphragmatic hernia treated with fetal endoscopic tracheal occlusion
Open Access
- 22 February 2010
- journal article
- research article
- Published by Wiley in Ultrasound in Obstetrics & Gynecology
- Vol. 35 (5), 572-577
- https://doi.org/10.1002/uog.7593
Abstract
Objective To evaluate the contribution of intrapulmonary artery Doppler in predicting the survival of fetuses with congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO). Methods A cohort of 41 fetuses (between 24 and 28 weeks of gestation) with CDH was treated with FETO. The observed/expected lung‐to‐head ratio (O/E‐LHR), pulmonary artery pulsatility index (PI), peak early diastolic reversed flow (PEDRF) and peak systolic velocity (PSV) were evaluated before FETO, and their isolated and combined value to predict survival using multiple logistic regression and decision‐tree analysis was assessed. Results O/E‐LHR and intrapulmonary artery PI and PEDRF were significantly associated with the probability of survival (O/E‐LHR ≥ 26%, OR 14.2; PI < 1 Z‐score, OR 8.4; and PEDRF < 3.5Z‐scores, OR 5.7). Decision‐tree analysis showed that O/E‐LHR was the best initial predictor of prognosis (O/E‐LHR ≥ 26%, 90% survival; O/E‐LHR < 26%, 45% survival). For fetuses with an O/E‐LHR of < 26%, Doppler parameters allowed discrimination of cases with moderate (66–71% survival) and very poor (0% survival) prognosis. Conclusion Intrapulmonary artery Doppler evaluation helps to refine the prediction of survival after FETO in fetuses with severe CDH. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.Keywords
This publication has 33 references indexed in Scilit:
- Liver position and lung-to-head ratio for prediction of extracorporeal membrane oxygenation and survival in isolated left congenital diaphragmatic herniaAmerican Journal of Obstetrics and Gynecology, 2007
- Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic herniaUltrasound in Obstetrics & Gynecology, 2007
- Prenatal detection and outcome of congenital diaphragmatic hernia: a French registry‐based studyUltrasound in Obstetrics & Gynecology, 2006
- Fetal Intervention for Congenital Diaphragmatic Hernia: The European ExperienceSeminars in Perinatology, 2005
- Effect of tracheal occlusion on peripheric pulmonary vessel muscularization in a fetal rabbit model for congenital diaphragmatic herniaAmerican Journal of Obstetrics and Gynecology, 2004
- Lung Pathology in Patients with Congenital Diaphragmatic Hernia Treated with Fetal Surgical Intervention, Including Tracheal OcclusionPediatric and Developmental Pathology, 2003
- Nihilism in the 1990s: The True Mortality of Congenital Diaphragmatic HerniaPediatrics, 2003
- Evaluation and Management of Congenital Diaphragmatic HerniaPediatric Case Reviews, 2001
- Tracheoscopic endotracheal occlusion in the ovine model: Technique and pulmonary effectsJournal of Pediatric Surgery, 1997
- Experimental fetal tracheal ligation and congenital diaphragmatic hernia: A pulmonary vascular morphometric analysisJournal of Pediatric Surgery, 1995