Link: https://www.ncbi.nlm.nih.gov/pubmed/30278985

J Pediatr Surg. 2018 Sep 9. pii: S0022-3468(130565-7. doi: 10.1016/j.jpedsurg.2018.08.057. [Epub ahead of print]
Prognostic utility of noninvasive estimates of pulmonary vascular compliance in neonates with congenital diaphragmatic hernia.
Aggarwal S1, Shanti C2, Lelli J2, Natarajan G3.
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Abstract
AIM:
To evaluate echocardiographic indices of pulmonary vascular resistance and right ventricular (RV) function in predicting death or ECMO in congenital diaphragmatic hernia (CDH).

METHODS:
In this single center study, early (<48 h) echocardiograms of neonates with CDH (n = 47) were reviewed by a single reader for the ratio of tricuspid regurgitant velocity to velocity time integral at the pulmonary valve (TRV/VTIpv), TRV2/VTIpv, RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE). Receiver operating characteristic curves were generated for each parameter to obtain optimal cutoff values.

RESULTS:
Infants who died or received ECMO (n = 30) had significantly higher TRV/VTIpv and TRV2/VTIpv, and lower VTIpv, RV FAC and TAPSE, compared to the 17 survivors without ECMO. For TRV2/VTIpv and TRV/VTI at cutoffs of 1.3 and 0.38 respectively, the sensitivities were 92.3 (95% CI 75-99.1%) and 96 (95% CI 80.4-99.9%), specificities were 78.6 (49.2-95.4%) and 71.4 (42-91.6%), positive predictive values were 89 (75-95.6%) and 86.2 (73.2-93.5%) and negative predictive values were 84.6 (58.5-95.5%) and 90.9 (58.7-98.6%).

CONCLUSION:
Early echocardiographic evidence of pulmonary hypertension and RV dysfunction predicts outcome in CDH. Further studies utilizing these indices to guide therapeutic decision-making are warranted.

LEVEL OF EVIDENCE:
Level 1 for diagnostic study.

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