Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology vol:37 issue:3 pages:264-71
RATIONALE: Pulmonary hypoplasia and hypertension are the main problems in newborns with isolated congenital diaphragmatic hernia (CDH). The outcome can be prenatally predicted by the measurement of contralateral lung size. Prenatal evaluation of lung vasculature has been much less investigated, and there are no data on the ability to predict pulmonary hypertension. OBJECTIVE: To predict neonatal survival and pulmonary hypertension by measurement of fetal pulmonary artery reactivity to maternal hyperoxygenation in fetuses with severe CDH treated by fetoscopic endoluminal tracheal occlusion (FETO). METHODS: 38 fetuses underwent FETO around 28 wks and the balloon was removed at 34 weeks. We performed a hyperoxygenation test and measured the lung-to-head ratio before and after each procedure. Outcome measures were neonatal survival, occurrence of pulmonary hypertension and its response to inhaled-NO (iNO) RESULTS: Fetuses who survived had a larger increase in lung size and decrease of resistance in the first branch of the main pulmonary artery, than those who died. Both measures were also predictive of pulmonary hypertension unresponsive to iNO. The hyperoxygenation test and lung-to-head-ratio were both best predictive for neonatal survival when measured following balloon removal (p<0.002). Discriminant analysis confirmed that these two parameters are independent predictors of outcome. CONCLUSIONS: In fetuses undergoing FETO, pulmonary vascular reactivity in relation to oxygen and lung size are independent predictors of neonatal survival, and pulmonary hypertension. The hyperoxygenation test merits further study in expectantly managed cases. Copyright (c) 2010 ISUOG. Published by John Wiley & Sons, Ltd.