Fetal Diagn Ther
. 2026 Jan 26:1-19.
doi: 10.1159/000550641. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/41587126/
Mediastinal shift angle (MSA) and its association with neonatal mortality in fetuses with isolated left congenital diaphragmatic hernia
Donatella Gerulewicz-Vannini, Edgar Hernandez-Andrade, Dejian Lai, Ramesha Papanna, Jimmy Espinoza, Sami Backley, Felicia Venable Lemoine, Matthew T Harting, Ashley H Ebanks, Anthony Johnson
- PMID: 41587126
- DOI: 10.1159/000550641
Abstract
Background: The mediastinal shift angle (MSA) estimates the lateral displacement of the heart in the fetal thorax.
Objective: To evaluate the MSA’s performance in predicting neonatal mortality in fetuses with left isolated congenital diaphragmatic hernia (CDH) as an isolated marker, and in combination with other ultrasound and MRI predictors.
Study design: MSA was obtained by ultrasound in a cross-sectional four-chamber view of the thorax in 96 fetuses with left isolated CDH. MSA was calculated by drawing two lines from a common point from the skin edge posterior to the spinous process of the thoracic vertebrae, the first line dividing the thorax into two halves, and the second line directed to the lateral border of the right atrium. Additionally, the observed/expected (O/E) lung-to-head ratio LHR, O/E total fetal lung volume (TFLV), and percentage of liver herniation (%LH) were obtained. ROC analysis, prediction, and associations with neonatal mortality were evaluated.
Results: Neonatal mortality was 28.1% (27/96). The areas under (AU) the ROC curve for neonatal mortality for MSA and O/E LHR were 0.69 and 0.75, respectively. The best MSA cut-off value was 35° with 85.2% sensitivity and 67.1% specificity; aOR 11.75 (95% CI 3.63-37.97; p<0.0001). Among fetuses with O/E LHR >25% (n=75), mortality was 16% (12/75), MSA ≥35° showed an AU-ROC of 0.72 with 83.3% sensitivity and 71.4% specificity, aOR 12.5 (95% CI 2.49-62.76; p=0.002). Logistic regression showed a significant correlation between MSA and O/E LHR (-0.48, p<0.001), between MSA and O/E TFLV (-0.36, p=0.005), and between MSA and %LH (0.43, p=0.001). When MSA and O/E LHR were combined, the AU-ROC for neonatal mortality was 0.832; when MSA, O/E LHR, and O/E TFLV were combined, the AU-ROC was 0.901. Conclusion MSA is a good predictor of neonatal mortality in fetuses with left isolated CDH. The prediction improves when MSA, O/E LHR and O/E TFLV are combined.
S. Karger AG, Basel.
About The Author
