Left Heart Structures in Human Neonates with Congenital Diaphragmatic Hernia and the Effect of Fetal Endoscopic Tracheal Occlusion

Abstract

Background: Small left heart structures are observed in fetuses with left-sided congenital diaphragmatic hernia (CDH). Fetoscopic tracheal occlusion (FETO) in mid-gestation promotes lung growth in fetuses with CDH, however cardiac effects of FETO are poorly described. We studied the effects of FETO on cardiac structure size at birth, hypothesizing that left heart structures would be larger in neonates who had undergone fetal intervention. Methods/Results: We performed retrospective measurements of atrioventricular and semilunar valve and pulmonary artery diameters, ventricular lengths, left ventricular end-diastolic volume indexed (LVEDVi) to body surface area. 35 patients were studied (9 FETO, 26 controls). All fetuses had liver herniation and a lung-to-head ratio <1 at fetal presentation. At birth the intervention group had larger LVEDVi (16.8 vs. 12.76 ml/m², p < 0.05), LV length Z-score (-2.05 vs. -4, p < 0.01), LV:RV length ratio (1.43 vs. 1.04, p < 0.05), LPA diameter Z-score (+1.71 vs. -1.04, p < 0.05), and better growth of aortic valve (-2.18 FETO, -3.3 controls, p < 0.01). There was a trend toward higher LV output in the FETO group. Conclusions: Left heart structures and LPA were larger postnatally in patients with CDH who underwent FETO than in those who did not. Hemodynamic alterations are introduced with tracheal occlusion that are associated with alterations in ventricular loading and may influence growth.

Severe left diaphragmatic hernia limits size of fetal left heart more than does right diaphragmatic hernia

“…Our observations are a step towards understanding the origins of left heart hypoplasia in CDH, though future studies that include additional postnatal data analysis are needed to confirm the significance of these observations in CDH patients. Better understanding of fetal alterations in left heart development and hemodynamics may have important clinical implications regarding fetal counseling, management and interventions such as tracheal occlusion.…”

Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta‐analysis

“…A total of 858 records were identified, of which 90 were retrieved for full‐text review. Twenty‐five articles published between 2003 and 2022 were included in the qualitative synthesis 12–36 , and data from 20 articles were included in the quantitative synthesis (Figure 1) 12–14,17–19,21–25,27–30,32–36 . Among them, the four RCTs 12–14, 21 were rated as having a low risk of bias using the RoB‐2 tool, while, among the 16 cohort studies 17–19,22–25,27–30,32–36 , three were rated as having a low risk, 11 were rated as having a moderate risk and two were rated as having a serious risk of bias using the ROBINS‐I tool (Table 1, Figure 2).…”

Clinical cardiac assessment in newborns with prenatally diagnosed intrathoracic masses

“…The concept of left-sided cardiac underdevelopment could be highlighted also by the increased frequency of left-sided CHD (11–29%) in the CDH population, ranging from severe hypoplastic left heart syndrome to asymptomatic bicuspid aortic valve or VSD [ 18 , 25 – 28 ]. We can confirm this high prevalence of left CHD, but without the influence of the laterality of the malformation.…”