Ventricular Performance is Associated with Need for Extracorporeal Membrane Oxygenation in Newborns with Congenital Diaphragmatic Hernia - 23/11/17
, Shazia Bhombal, MD, FAAP 2, 3, Krisa Van Meurs, MD, FAAP 2, 3, Theresa A. Tacy, MD, FAAP 1, 3Abstract |
Objective |
To compare echocardiography (ECHO) findings of patients with congenital diaphragmatic hernia (CDH) who required extracorporeal membrane oxygenation (ECMO) to non-ECMO treated patients.
Study design |
We reviewed clinical and ECHO data of newborns with CDH born between 2009 and 2016. Exclusions included major anomalies, genetic syndromes, or no ECHO prior to ECMO. Pulmonary hypertension was assessed by ductal shunting and tricuspid regurgitant jet. Speckle tracking echocardiography (STE) assessed function by quantifying deformation.
Results |
Patients with CDH (15 ECMO and 29 with no ECMO) were analyzed. Most patients had a left CDH (88.6%). Age at ECHO was similar between groups. Outborn status (P = .009) and liver position (P = .009) were associated with need for ECMO. Compared with non-ECMO patients, patients who required ECMO had significantly decreased left and right ventricular function by both conventional and STE measures, as well as decreased right and left ventricular output. The right ventricular eccentricity index was higher in ECMO vs non-ECMO patients (2.2 vs 1.8, P = .02). There was no difference in pulmonary hypertension between CDH groups.
Conclusions |
Need for ECMO was associated with decreased left and right ventricular function, as assessed by standard and STE measures. There was no difference in pulmonary hypertension between non ECMO and ECMO patients. Abnormal cardiac function may explain nonresponse to pulmonary vasodilators in patients with CDH. Management strategies to improve cardiac function may reduce the need for ECMO in newborns with CDH.
Le texte complet de cet article est disponible en PDF.Keywords : congenital diaphragmatic hernia, pulmonary hypertension, ventricular performance, speckle tracking echocardiography, echocardiography, right ventricle, left ventricle, deformation analysis, longitudinal strain, ECMO, extracorporeal membrane oxygenation, neonatal cardiovascular physiology, cardiac function, velocity vector imaging, persistent pulmonary hypertension of the newborn, neonatology, newborn
Abbreviations : AT/RVET, CDH, ECMO, EDSR, EF, FAC, iNO, LVOT, pGLS, pGLSR, PW, RVOT, sBP, sPAP, STE, TAPSE, VTI
Plan
| The authors declare no conflicts of interest. |
Vol 191
P. 28 - décembre 2017 Retour au numéro
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