Lung tissue perfusion in congenital diaphragmatic hernia and association with the lung to head ratio and intrapulmonary pulsed Doppler
Moreno-Alvarez, Oscar × Cruz-Martinez, Rogelio Hernandez-Andrade, Edgar Done, Elisa Gómez, Olga Deprest, Jan Gratacos, Eduard #
Ultrasound in Obstetrics & Gynecology vol:35 issue:5 pages:578-582
OBJECTIVE:: To evaluate lung tissue perfusion in fetuses with congenital diaphragmatic hernia (CDH) and to explore its association with the lung to head ratio (LHR) and intrapulmonary pulsed Doppler. METHODS:: Fetuses with isolated left CDH were evaluated and compared with a group of normally grown fetuses sampled from our general population and matched by gestational age at inclusion. Lung tissue perfusion measured by Fractional Moving Blood Volume (FMBV), the Observer to expected (O/E) LHR, and pulsed Doppler of the proximal intrapulmonary artery were evaluated in the contralateral lung to the side of the hernia. Doppler waveform analysis included the Pulsatility Index (PI), Peak Early Diastolic Reverse Flow (PEDRF) and Peak Systolic Velocity (PSV). All Doppler parameters were converter into z-scores for gestational age. The association between FMBV with O/E LHR and intrapulmonary arterial Doppler parameters was analyzed by multiple linear regression, adjusted by gestational age. RESULTS:: A total of 190 fetuses (95 CDH and 95 controls) were evaluated. Fetuses with CDH showed significantly lower lung FMBV (26.8 (SD 8.4) vs. 37.9 (SD 8.1); p<0.001) than controls. Lung tissue perfusion correlate positively with the O/E LHR (r=0.37 p<0.001) and negatively with PI (r=-0.31 p<0.001), PEDRF (r=-0.43 p<0.001) and PSV (r=-0.18 p=0.03). CONCLUSION:: CDH fetuses have decreased lung tissue perfusion, which is associated with decreased lung growth and increased intrapulmonary impedance. Copyright (c) 2010 ISUOG. Published by John Wiley & Sons, Ltd.