Fetal Lung Volume Estimated by 3‐Dimensional Ultrasonography and Magnetic Resonance Imaging in Cases With Isolated Congenital Diaphragmatic Hernia

Ruano, Rodrigo; Joubin, Laurence; Sonigo, P.; Benachi, Alexandra; Aubry, Marie Cécile; Thalabard, J. C.; Brunelle, Françis; Dumez, Yves; Dommergues, Marc

doi:10.7863/jum.2004.23.3.353

Cited by 87 publications

(79 citation statements)

References 19 publications

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“…Ipsilateral fetal lung volumes were measured by the same technique previously described in the literature [19][20][21][22][23] , using a Voluson 730 ultrasound machine (Kretztechnik, General-Electric, Zipf, Austria) with a 4-to 8-MHz transducer for three-dimensional volume scanning. A transverse section of the fetal thorax at the level of the four chamber view, with the fetal heart proximal to the transducer, was identified by 2DUS and the volume box was adjusted in order to scan the entire fetal thorax.…”

Section: Methodsmentioning

confidence: 99%

“…Total and contralateral fetal lung volumes can be measured precisely on 3DUS [23,24] correlating significantly with neonatal deaths [21,24] . Total fetal lung can be calculated using the rotational technique (VOCAL TM ) by summing the right and left lung volumes [19][20][21][22][23] . Initial results showed that an observed/expected total fetal lung volume ratio (o/e-TotFLVR) lower than 0.35 was significantly associated with neonatal deaths [21] , confirming the results of previous studies using MRI [15][16][17][18] .…”

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Ipsilateral Lung Volumes Assessed by Three-Dimensional Ultrasonography in Fetuses with Isolated Congenital Diaphragmatic Hernia

et al. 2008

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Objective: To evaluate the precision of three-dimensional ultrasonography (3DUS) in estimating the ipsilateral lung volume and the potential of this measurement to predict neonatal death in congenital diaphragmatic hernia (CDH). Methods: Between January 2002 and December 2004, the ipsilateral lung volumes were assessed by 3DUS using the technique of rotation of the multiplan imaging in 39 fetuses with CDH. The observed/expected ipsilateral lung volume ratios (o/e-IpsiFLVR) were compared to the lung/head ratios (LHR) and to the observed/expected total fetal lung volume ratios (o/e-TotFLVR) as well as to postnatal death. Results: Ipsilateral lung volumes (median 0.12, range 0.01–0.66) were more reduced than the total lung volumes (median 0.52, range 0.11–0.95, p < 0.001) in CDH. The bias and precision of 3DUS in estimating ipsilateral lung volumes were –0.61 and 0.99 cm³, respectively, with absolute limits of agreement from –2.56 to +1.33 cm³. The o/e-IpsiFLVR was lower in neonatal death cases (median 0.09, range 0.01–0.46) than in survivals (median 0.18, range 0.01–0.66), but this difference was not statistically significance (p > 0.05). The sensitivity, specificity, (positive and negative) predictive values and accuracy of o/e-IpsiFLVR in predicting neonatal death was 52.6% (10/19), 83.3% (10/12), 83.3% (10/12), 52.6% (10/19) and 64.5% (20/31), respectively. Conclusion: Although the ipsilateral lung volume can be measured by 3DUS, it cannot be used to predict neonatal death when considering it alone. However, it is important to measure it to calculate the total fetal lung volumes as the o/e-TotFLVR has the best efficacy in predicting neonatal death in isolated CDH.

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Ipsilateral Lung Volumes Assessed by Three-Dimensional Ultrasonography in Fetuses with Isolated Congenital Diaphragmatic Hernia

et al. 2008

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“…1,7 Nevertheless, in spite of the great advances in prenatal and postnatal diagnosis and management, the mortality rate in neonates with isolated CDH is still high. 8 Recent research has focused on prenatal predictors of neonatal outcome in isolated CDH cases, such as lung/head ratio 9,10 and fetal lung volume, [11][12][13][14][15][16] to differentiate cases with a worse prognosis, in which fetal therapy or termination of pregnancy may be indicated, from those with better prognosis, requiring only specialized postnatal care. [17][18][19] In spite of the worldwide, published experience, there are no data about perinatal results in cases of prenatally diagnosed CDH in Brazil.…”

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confidence: 99%

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Ruano

Bunduki

Silva

et al. 2006

Clinics

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diagnosis and perinatal outcome of 38 cases with congenital diaphragmatic hernia: 8-year experience of a tertiary Brazilian center. Clinics. 2006;61(3):197-202. PURPOSE:To evaluate the perinatal results for neonates with congenital diaphragmatic hernia diagnosed prenatally. METHOD: We reviewed data from 38 cases of congenital diaphragmatic hernia diagnosed prenatally from January 1995 to December 2003 in the Fetal Medicine Unit of the Department of Obstetrics and Gynecology, São Paulo University Medical School. The main data analyzed were gestational age at diagnosis, fetal karyotyping, side of diaphragmatic defect, presence of associated structural malformations, hepatic herniation, and severe mediastinal shift. Perinatal outcomes were obtained by reviewing hospital documents or by directly calling the patients' immediate relatives. RESULTS: Mean gestational age at diagnosis was 29 weeks (range, 16-37 weeks).Thirty (79%) cases had a left diaphragmatic defect and 8 (21%) had a right lesion. Associated structural malformations were observed in 21 (55%) cases, in which 12 fetuses had a normal karyotype and 9 had chromosomal abnormalities. Isolated congenital diaphragmatic hernia was confirmed in 17 (45%) cases. The overall perinatal mortality rate was 92%. Rates of fetal deaths, early neonatal deaths, late neonatal deaths, and survival were 42%, 50%, 0%, and 8%, respectively, in cases with associated structural malformations but normal karyotyping; 56%, 44%, 0%, and 0% for cases with chromosomal abnormalities; and, 0%, 76%, 12%, and 12% in cases with isolated congenital diaphragmatic hernia. The neonatal mortality rate was 89% in cases with isolated congenital diaphragmatic hernia. CONCLUSION: Perinatal mortality was very high in prenatally diagnosed cases of congenital diaphragmatic hernia. Earlier perinatal deaths are associated with the presence of other structural defects or chromosomal abnormalities. In cases of isolated congenital diaphragmatic hernia, mortality is related to the presence of herniated liver, right-sided lesion, and major mediastinal shift.

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“…fetuses with extremely reduced lung volumes, liver herniation and decreased pulmonary vascularization [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] . Neonatal deaths among severe CDH cases occur due to severe pulmonary hypoplasia and pulmonary arterial hypertension [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] .…”

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Comparison between Fetal Endoscopic Tracheal Occlusion Using a 1.0-mm Fetoscope and Prenatal Expectant Management in Severe Congenital Diaphragmatic Hernia

Ruano¹,

Duarte²,

Pimenta³

et al. 2010

Fetal Diagn Ther

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Objectives: To evaluate if fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) using a 1.0-mm fetoscope improves neonatal outcome. Method: Between January 2006 and December 2008, a controlled study was conducted at a single center in which FETO was proposed for fetuses with severe isolated CDH (lung-to-head ratio <1.0) and liver herniation to the thoracic cavity but no other detectable anomalies at diagnosis (<26 weeks). FETO was performed under maternal epidural and fetal intramuscular anesthesia, guided by ultrasonography and 1.0-mm fetoscope between 26 and 30 weeks. All cases submitted to FETO were delivered by ex utero intrapartum therapy procedure. Postnatal therapy was the same for both treated fetuses and controls. The primary outcome was neonatal survival (up to 28 days after birth). Results: A total of 35 women met the inclusion criteria, and in 17 of them, fetal intervention was intended. However, in 1 case, it was not possible to insert the balloon inside the fetal trachea because of placental bleeding. FETO was therefore successfully performed in 16 fetuses with severe CDH. Eighteen cases received no prenatal intervention and served as the control group. Mean gestational age at diagnosis was similar in both groups (p > 0.05). Delivery occurred at 35.6 (range: 28–38) weeks in the FETO group and at 37.5 (range: 31–40) weeks (p = 0.18) among controls. Nine of 17 (52.9%) infants in the FETO group and 1 of 18 (5.6%) in the control group survived (p < 0.01). Severe pulmonary arterial hypertension was present in 8/17 (47.1%) infants from the FETO group and in 16/18 (88.9%) controls (p = 0.01). Conclusion: The present study shows that FETO using a 1.0-mm fetoscope is feasible and may improve neonatal outcome in severe CDH.

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Fetal Lung Volume Estimated by 3‐Dimensional Ultrasonography and Magnetic Resonance Imaging in Cases With Isolated Congenital Diaphragmatic Hernia

Abstract: There is a good agreement between 3-dimensional ultrasonography and magnetic resonance imaging for fetal lung volume estimation in cases with congenital diaphragmatic hernia.

Cited by 87 publications

References 19 publications

Ipsilateral Lung Volumes Assessed by Three-Dimensional Ultrasonography in Fetuses with Isolated Congenital Diaphragmatic Hernia

Ipsilateral Lung Volumes Assessed by Three-Dimensional Ultrasonography in Fetuses with Isolated Congenital Diaphragmatic Hernia

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Comparison between Fetal Endoscopic Tracheal Occlusion Using a 1.0-mm Fetoscope and Prenatal Expectant Management in Severe Congenital Diaphragmatic Hernia

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