The relationship of pulmonary artery pressure and survival in congenital diaphragmatic hernia
Section snippets
Patient data
A retrospective analysis was performed of the charts of all infants with the diagnosis of CDH from this institution from January 1991 to June 2002. Infants with complex congenital heart disease or prematurity or those who had limited treatment, were excluded from the study group. Data collected included gender, birth weight, race, results of echocardiographic examinations, use of extracorporeal membrane oxygenation (ECMO) use of nitric oxide, and timing of surgical repair.
Management strategies
During this period,
Results
A total of 57 full-term CDH infants met the study qualifications. Sixty-five percent (65%) were outborn; 59% were boys. Long-term survival rate in this group was 74%.
Fifty percent of the entire group had pulmonary artery pressure (PAP) ratios less than 0.5 within the first 2 weeks of life, and 70% had such ratios by 2 months of age (Fig 1).
Of the 57 infants, 10 infants were then censored because of a lack of serial ECHO data. In this excluded group, there were 7 survivors and 3 deaths.
In these
Discussion
The clinical course of pulmonary hypertension and its relationship to outcome in patients with congenital diaphragmatic hernia has never been documented in a large study. The importance of pulmonary hypertension in ultimately determining survival rates has always been recognized, but establishing the boundary between reversible pulmonary hypertension and irreversible pulmonary hypoplasia has been impossible clinically. To this end, the acceptance and utilization of current clinical
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