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Research: Echocardiographic Assessment of Pulmonary Hypertension in Neonates with Congenital Diaphragmatic Hernia Using Pulmonary Artery Flow Characteristics

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Research: Echocardiographic Assessment of Pulmonary Hypertension in Neonates with Congenital Diaphragmatic Hernia Using Pulmonary Artery Flow Characteristics

J Clin Med

. 2022 May 27;11(11):3038.

 doi: 10.3390/jcm11113038. https://pubmed.ncbi.nlm.nih.gov/35683426/

Echocardiographic Assessment of Pulmonary Hypertension in Neonates with Congenital Diaphragmatic Hernia Using Pulmonary Artery Flow Characteristics

Florian Kipfmueller 1 2Suemeyra Akkas 1Flaminia Pugnaloni 1 3Bartolomeo Bo 1Lotte Lemloh 1Lukas Schroeder 1Ulrich Gembruch 4Annegret Geipel 4Christoph Berg 4 5Andreas Heydweiller 2 6Andreas Mueller 1 2

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Free PMC article

Abstract

Background: Assessment of pulmonary hypertension (PH) is essential in neonates with congenital diaphragmatic hernia (CDH). Echocardiography is widely established to quantify PH severity, but currently used parameters have inherent limitations. The aim of our study was to investigate the prognostic utility of the index of the pulmonary artery acceleration time to the right ventricular ejection time (PAAT:ET) in CDH neonates assessed using echocardiography.

Methods: PAAT:ET values were prospectively measured in CDH neonates on admission, on day of life (DOL) 2 and DOL 5-7. Optimal cut-off values to predict mortality and need for ECMO were calculated and PAAT:ET values were compared between non-ECMO survivors, ECMO-survivors, and ECMO-non-survivors.

Results: 87 CDH neonates were enrolled and 39 patients required ECMO therapy. At baseline, PAAT:ET values were significantly lower in ECMO patients compared to non-ECMO patients (p < 0.001). ECMO survivors and ECMO non-survivors had similar values at baseline (p = 0.967) and DOL 2 (p = 0.124) but significantly higher values at DOL 5-7 (p = 0.003). Optimal PAAT:ET cut-off for predicting ECMO was 0.290 at baseline and 0.310 for predicting non-survival in patients on ECMO at DOL 5-7.

Conclusion: PAAT:ET is a feasible parameter for early risk assessment in CDH neonates.

Keywords: congenital diaphragmatic hernia; echocardiography; extracorporeal membrane oxygenation; pulmonary artery acceleration time; pulmonary hypertension.

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