Echocardiography derived pulmonary artery capacitance and right ventricular outflow velocity time integral on first day of life can predict survival in congenital diaphragmatic hernia

Abstract

Correlation between right ventricle systolic pressure (derived from moderate/severe tricuspid regurgitation) and survival of congenital diaphragmatic hernia (CDH) infants was established. We hypothesize that other non-tricuspid valve regurgitation (TR) dependent Echo parameters can predict CDH mortality. Our retrospective study included 20 CDH infants from January 2008 to September 2015. Inclusion criteria included: all CDH patients admitted to our neonatal intensive care unit. Exclusion criteria were: hereditary malformation of air ways, congenital heart disease other than patent ductus arteriosus (PDA) and/or PFO (patent foramen ovale) or atrial septal defect (ASD), sepsis, genetic syndromes and high frequency ventilation usage. Relevant non-Echo data was collected. The following Echo parameters were evaluated: severity of TR, ratio between systolic and diastolic duration of right ventricle (RV), pulmonary artery capacitance (PAC), RV outflow tract velocity time integral (RVOT VTI), and others.CDH survivors showed higher RVOT VTI (12.3±3ml vs 9±3.1ml), and higher PAC (0.3±0,2ml3×mmHg−1 versus 0.18±0.07m3×mmHg−1). Cronbach's alpha for intra-rater reliability was 0.82 for PAC and 0.98 for RVOT VTI and for inter-rater reliability was 0.74 and 0.89 consecutively. RVOT VTI of value >10.5ml and PAC of value >0.24ml3×mmHg−1 differentiated CDH survivors with area under curve (AUC) 0.78(p=0.02) and AUC 0.89(p=0.002) consecutively with sensitivity and specificity for both >70%. Proportional Hazard analysis showed PAC<0.24 has a mortality risk ratio of 25.8 versus 4.36 for RVOT VTI <10.5. First 24h echo derived (PAC) and (RVOT VTI) can predict survivors in congenital diaphragmatic hernia patients.