Contribution of pulmonary Doppler to improve prediction of survival in fetuses with congenital diaphragmatic hernia treated with fetal endoscopic tracheal occlusion
Cruz-Martinez, Rogelio × Moreno-Alvarez, Oscar Hernandez-Andrade, Edgar Castañon, Montserrat Done, Elisa Martinez, Josep M Puerto, Bienvenido Deprest, Jan Gratacos, Eduard #
Ultrasound in Obstetrics & Gynecology vol:35 issue:5 pages:572-577
OBJECTIVE:: To evaluate the contribution of pulmonary Doppler for the prediction of survival in fetuses with congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO). METHODS:: A cohort of 41 fetuses with CDH between 24 to 28 weeks of gestation and treated with FETO. Observed/expected lung to head ratio (O/E-LHR), pulmonary Doppler Pulsatility Index (PI), Peak Early Diastolic Reverse Flow (PEDRF) and Peak Systolic Velocity (PSV) were evaluated before FETO, and their isolated and combined value to predict survival using multiple logistic regression and decision tree analysis was assessed. RESULTS:: O/E-LHR, Doppler PI and PEDRF were significantly associated with the probability of survival (O/E-LHR >/=26% OR 14.2, PI <1 z-score OR 8.4, and PEDRF <3.5 z-score OR 5.7). Decision tree analysis showed that O/E-LHR was the best initial predictor of prognosis (O/E-LHR >/=26%: 90% survival; O/E-LHR<26%: 45% survival). For cases with O/E-LHR<26%, Doppler parameters allowed to discriminate cases with moderate (66-71% survival) and very poor (0% survival) prognosis. CONCLUSION:: Intrapulmonary Doppler evaluation helps to refine the prediction of survival after FETO in fetuses with severe CDH. Copyright (c) 2010 ISUOG. Published by John Wiley & Sons, Ltd.