Fetal diaphragmatic hernia: Ultrasound diagnosis and clinical outcome in 38 cases

Adzick, N. Scott; Vacanti, Joseph P.; Lillehei, C. Walton; O’Rourke, P. Pearl; Crone, Robert K.; Wilson, Jay M.

doi:10.1016/s0022-3468(89)80713-4

Cited by 184 publications

(90 citation statements)

References 17 publications

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“…8 Many sonographic parameters have been proposed to predict the prognosis of CDH. Polyhydramnios in the third semester, 10 early diagnosis (less than 25 weeks' gestation), 4 presence of an intrathoracic stomach, 11 small lung-thorax transverse area ratio, 12 underdevelopment of the left heart, 13 and visceral herniation 14 have all been evaluated, but none of these has been widely accepted or applied clinically.…”

Section: Discussionmentioning

confidence: 99%

Congenital diaphragmatic hernia without herniation of the liver: does the lung-to-head ratio predict survival?

Sbragia

Paek

Filly

et al. 2000

Journal of Ultrasound in Medicine

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The purpose of the present study was to determine the ability of lung‐to‐head ratio to predict survival and need for extracorporeal membrane oxygenation support in fetuses with left congenital diaphragmatic hernia without herniation of the liver into the chest. The perinatal records of 20 fetuses with isolated left congenital diaphragmatic hernia without herniation of the left lobe of the liver into the chest were reviewed. Fetuses were stratified into two groups depending on lung‐to‐head ratio: those with a ratio of less than 1.4 (historically a poor prognosis group) and those with a ratio of greater than 1.4. The outcome of both groups was compared with chi‐square analysis. Eight of 11 fetuses with a lung‐to‐head ratio greater than 1.4 survived, whereas 8 of 9 fetuses with a ratio of less than 1.4 survived. No differences were noted in the need for extracorporeal membrane oxygenation support or survival between the two groups. Fetuses with a prenatally diagnosed left congenital diaphragmatic hernia without herniation of liver into the chest have a favorable prognosis even in the presence of a low lung‐to‐head ratio.

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Section: Discussionmentioning

confidence: 99%

Congenital diaphragmatic hernia without herniation of the liver: does the lung-to-head ratio predict survival?

Sbragia

Paek

Filly

et al. 2000

Journal of Ultrasound in Medicine

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show abstract

“…However, the morbidity and mortality associated with such in utero operative correctio is a major concern (17)(18)(19)(20)(21)(22). Precise monitoring of maternal and fetal pressures is an important element in reducing operative risks associated with fetal corrective surgery lessen the risks of fetal surgery, one must be familiar not only with the fetal vascular anatomy, but also with the pressure limitations of the fetal cardiovascular system (23, Results of this study give a better understanding of the fragility and pressure ons of the fetal cardiovascular system (25)(26)(27).…”

Section: Resultsmentioning

confidence: 99%

The use of pressure monitoring to standardize fetal arterial visualization

Shemshadi¹,

Rohrich²

1996

CAN J PLAST SURG

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H Shemshadi, RJ Rohrich, L Li, JB Robinson Jr. The use of pressure monitoring to standardize fetal arterial visualization. Can J Plast Surg 1996;4(3):161-164. The application of a new x-ray opaque postmortem perfusion system for the visualization of vascular structures in fetal models is presented. This new system allows pig fetus perfusion to be performed at pressures of less than 30 mmHg. At higher pressures, extravasations were observed in known weak spots in the fetal vasculature, and multiple perfusions at the same pressure exhibited similar patterns of extravasation (demonstrated at all pressures studied). Therefore this technique is controllable and predictable. It will allow determination of fetal vascular malformations which have been implicated as causes of many birth defects. Key Words: Anatomy, Birth detects, Fetus, Perfusion, VasculatureRecours à la surveillance de la tension pour normaliser la visualisation artérielle foetale RÉSUMÉ : L'application d'un nouveau système de perfusion post-mortem radio-opaque pour la visualisation des structures vasculaires dans des modèles foetaux est présentée ici. Le nouveau système permet d'effectuer des perfusions chez des porcelets à des pressions de moins de 30 mm Hg. À des pressions plus élevées, on observait de l'extravasation en certains points faibles connus de l'appareil vasculaire foetal et les multiples perfusions à la même pression présentaient des modes similaires d'extravasation (démontrés à toutes les pressions étudiées). Par conséquent, cette technique peut être contrôlée et prévisible. Elle permet la détermination des malformations vasculaires foetales incriminées dans de nombreuses anomalies congénitales.Fetal anatomical vasculature has been extensively studied with respect to the differences in developmental stages (1), patterns of branches, number of branches and anatomical weak points (2). With the recent advances in fetal reconstructive surgery (3), one must not only have basic knowledge of fetal anatomy but must also correlate such knowledge with the physiological changes and pressure tolerances of the fetal vascular system before performing a surgical procedure aimed at correcting an intrauterine anomaly.This study attempted to standardize a method of fetal arterial vascularization at different perfusion pressures and observe any vascular extravasations that may have been caused by increases in perfusion pressure and that are not present in the intact fetus, and to visualize what points of the fetal vascular anatomy are most susceptible to this CAN

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“…(Done, Gucciardo et al 2008) Previously the outcome of fetuses with prenatally diagnosed CDH was thought to be poor, (Adzick, Vacanti et al 1989) however as many cases are now diagnosed antenatally, prenatal diagnosis can no longer be considered a useful predictor of poor outcome.…”

Section: Prenatal Diagnosis Of Congenital Heart Disease Associated Wimentioning

confidence: 99%

Congenital Diaphragmatic Hernia and Congenital Heart Disease

Armstrong¹,

Franklin²,

Molloy³

2012

Congenital Diaphragmatic Hernia - Prenatal to Childhood Management and Outcomes

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Fetal diaphragmatic hernia: Ultrasound diagnosis and clinical outcome in 38 cases

Cited by 184 publications

References 17 publications

Congenital diaphragmatic hernia without herniation of the liver: does the lung-to-head ratio predict survival?

Congenital diaphragmatic hernia without herniation of the liver: does the lung-to-head ratio predict survival?

The use of pressure monitoring to standardize fetal arterial visualization

Congenital Diaphragmatic Hernia and Congenital Heart Disease

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