Ventricular Dysfunction, Interdependence, and Mechanical Dispersion in Newborn Infants with Congenital Diaphragmatic Hernia

Abstract

Background: Congenital diaphragmatic hernia (CDH) is an important cause of mortality and morbidity in the neonatal period. Pulmonary hypertension and pulmonary hypoplasia are key pathological findings. Cardiac function may also be an important determinant of disease severity, prognostic indicator, and therapeutic target in CDH. Objective: The aim of this study was to assess ventricular mechanics and synchrony in infants with CDH and controls using speckle tracking echocardiography (STE). Methods: Retrospective analysis was performed of echocardiograms obtained in the first 48 h of life in 27 infants with CDH and 20 controls. STE-derived longitudinal strain (LS) was measured in the right and left ventricles (RV, LV). Circumferential strain (CS) and radial strain (RS) were additionally measured in the LV. Mechanical dispersion (MD), a measure of synchrony, was assessed by calculation of the standard deviation of time to peak systolic strain in six ventricular segments. Results: RV LS and LV LS, LV CS, and LV RS were significantly reduced in CDH compared to controls. In the LV free wall, LS and RS were significantly reduced in CDH. LV LS correlated significantly with RV LS in CDH cases (r² = 0.37, p = 0.002), but not controls (r² = 0.19, p = 0.06). LV LS also correlated with LV MD in CDH (r² = 0.25, p = 0.01) but not controls (r² = 0.02, p = 0.54). Conclusions: Global impairment of RV and LV systolic function are present in newborn infants with CDH and are associated with primary left ventricular dysfunction, ventricular interdependence, and MD.

Myocardial strain on admission predicts disease severity in infants hospitalized for bronchiolitis

“…Mechanisms of ventricular interdependence, including the shared septum, muscle fibers, and pericardial space shared, may also contribute to biventricular dysfunction 24,25 . Supporting this hypothesis and the relationship between cardiac function and disease severity, we observed that cases with biventricular impairment required higher levels of respiratory support and prolonged hospital stay compared to those with normal function.…”

Early, Postnatal Pulmonary Hypertension Severity Predicts Inpatient Outcomes in Congenital Diaphragmatic Hernia

“…The CDHSG collects data obtained during patient care without imposing any mandates on participating centers to obtain studies at specific intervals; however, general practice recommendations in CDH include obtaining an echocardiogram within the first 24-48 HOL [14,15]. Additionally, previous studies have defined the first 48 HOL as a critical time frame for initial CDH-PH evaluation [15][16][17].…”

The Role of Lung Function Testing in Newborn Infants With Congenital Thoracic Arterial Anomalies

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