98 - Usefulness of left pulmonary artery to main pulmonary artery ratio measured by echocardiography for predicting risk of death or ECMO in congenital diaphragmatic hernia

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 98
Publication Number: 98.425

Sunghyeon Park, Asan Medical center, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Euiseok Jung, Asan Medical Center, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Ha Na Lee, Asan medical center, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Jeong Min Lee, Asan medical center, seoul, Seoul-t'ukpyolsi, Republic of Korea; Jiyoon Jeong, Asan Medical Center Children's Hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Byong Sop Lee, Asan Medical Center, Seoul, Seoul-t'ukpyolsi, Republic of Korea

Presenting Author(s)

Sung Hyeon Park, bachelor

Fellow
Asan Medical center
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Background:

Despite advances in the management of congenital diaphragmatic hernia (CDH), morbidity and mortality remain high, mainly due to pulmonary hypertension, along with pulmonary hypoplasia and hypoplastic pulmonary vasculature. Few studies have been conducted on pulmonary artery measurement by echocardiography in neonates with CDH.

Objective:

The purpose of this study was to predict whether underdevelopment of the left pulmonary artery measured by echocardiography immediately after birth in left CDH was related to death or the need for ECMO.

Design/Methods: This study is a retrospective study of left CDH newborns born between 2018 and 2022 in a single tertiary medical institution. Preterm infants under 34 weeks of gestational age, major congenital anomalies, chromosomal abnormalities, and absence of echocardiography immediately after birth were excluded. Diameter of left pulmonary artery (LPA) was measured at bifurcation, and diameter of main pulmonary artery (MPA) was used as a measure of maximal dimension during systolic phase. The McGoon index, Nakata index, and ejection fraction (EF) were analyzed in comparison with the LPA/MPA ratio as predictive values. Statistical analyses included univariate analysis, logistic regression analysis and receiver operating characteristic curves.

Results:

Seventy left CDH neonates were included, 17 (24.3%) died or need of ECMO and 53 (75.7%) survived without ECMO. Survival group had higher observed/expected lung to head ratio (o/e LHR) by prenatal ultrasound (P = 0.000), lower presence of liver herniation (P = 0.000), lower incidence of patch repair (P = 0.000). Lower o/e LHR, lower EF, lower LPA/MPA ratio, lower Nakata index, and lower McGoon index measured by echocardiography immediately after birth were risk factors for death or need of ECMO. Among the measurements LPA/MPA ratio had the highest AUC (0.967) with a sensitivity of 88.2% and specificity of 84.9% at a cut-off value of 33.6%.

Conclusion(s): In left CDH patients, the LPA/MPA ratio measured by echocardiography immediately after birth can be used as a predictor of death or need for ECMO.