J Pediatr
. 2023 May 31;113530.
doi: 10.1016/j.jpeds.2023.113530. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/37268035/
Congenital Heart Disease With Congenital Diaphragmatic Hernia: Surgical Decision Making and Outcomes
Latoya A Stewart 1, Rebecca R Hernan 2, Christopher Mardy 3, Eunice Hahn 3, Wendy K Chung 2, Emile A Bacha 4, Ganga Krishnamurthy 2, Vincent P Duron 5, Usha S Krishnan 6
Affiliations expand
- PMID: 37268035
- DOI: 10.1016/j.jpeds.2023.113530
Abstract
Objectives: To describe the types of congenital heart disease (CHD) in a congenital diaphragmatic hernia (CDH) cohort in a large volume center and evaluate surgical decision making and outcomes based on complexity of CHD and associated conditions.
Study design: A retrospective review of patients with CHD and CDH diagnosed by echocardiogram between 01/01/2005 and 07/31/2021. The cohort was divided into two groups based on survival at discharge.
Results: Clinically important CHD was diagnosed in 19% (62/326) of CDH patients. There was 90% (18/20) survival in children undergoing surgery for both CHD and CDH as neonates, and 87.5 (22/24) in those undergoing repair initially for CDH alone. A genetic anomaly identified on clinical testing was noted in 16% with no significant association with survival. A higher frequency of other organ system anomalies was noted in non-survivors compared with survivors. Non-survivors were more likely to have unrepaired CDH (69% vs 0%, p<0.001) and unrepaired CHD (88% vs 54%, p<0.05), reflecting a decision not to offer surgery.
Conclusions: Survival was excellent in patients who underwent repair of both CHD and CDH. Patients with univentricular physiology have poor survival and this finding should be incorporated into pre- and post-natal counseling about eligibility for surgery. In contrast, patients with other complex lesions including transposition of the great arteries have excellent outcomes and survival at 5 years of age with follow-up at a large pediatric and cardiothoracic surgical center.
Keywords: cardiac and thoracic surgery; genetics; outcomes; prenatal counseling.
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