EP06.13: Mediastinal shift angle and cardiomediastinal shift angle as a simple and stable method in evaluating prognosis of congenital diaphragmatic hernia
Year: 2024
Type: conference-abstract
Abstract: To explore the value of Mediastinal Shift Angle (MSA) and Cardiomediastinal Shift Angle (CMSA) as a simple and stable method in evaluating left congenital diaphragmatic hernia (CDH). A prospective cohort study involved 100 normal fetuses (control group) and 186 ones diagnosed with left congenital diaphragmatic hernia (study group) were carried out in a single tertiary centre. MSA and CMSA were measured on four-chamber view. Lung area to head circumference ratio (LHR), ratio of the observed/expected total fetal lung volume (O/E LHR) were also measured. Outcomes of all fetuses were followed, intrauterine fetal therapy, pulmonary hypertension (PH), extracorporeal membrane oxygenation (ECMO) use and survival were recorded in neonates. Efficiency estimation of postnatal outcomes of MSA and CMSA was compared with LHR, O/E LHR. Gestational weeks of fetuses diagnosed with congenital diaphragmatic hernia were from 16 to 32 weeks. Hernia sacs were found in 14 fetuses. The interobserver and intraobserver agreement of MSA (ICC = 0.96(95% CI 0.92-0.98)) and CMSA (ICC = 0.97 (95% CI 0.94-0.99)) were higher than LHR (ICC = 0.84(95% CI 0.80-0.88)). Compared to the control group, MSA and CMSA were much larger in fetus with left diaphragmatic hernia than normal ones in corresponding gestational weeks. MSA and CMSA was inversely correlated LHR, O/E LHR. MSA, CMSA, LHR, and O/E LHR could all be used to predict survival of CDH patients, they are similar to that of O/E LHR, but superior to LHR. When MSA is over 41.30 degree or CMSA is over 38.69 degree, it showed poor outcome for fetuses with left CDH. MSA was also correlated with PH, need for ECMO use. MSA and CMSA can be simple and quick ways to evaluate CDH fetus, they can also be used to predict survival of CDH patients, which are similar to that of O/E LHR, but superior to LHR.
DOI: 10.1002/uog.28186
Author: C. Zhong
Institution: Chongqing Maternal and Child Health Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4402359058