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03.01.2021 | Original Article

Optimization of surgical timing of congenital diaphragmatic hernia using the quantified flow patterns of patent ductus arteriosus

verfasst von: Yoshitaka Shinno, Keita Terui, Mamiko Endo, Takeshi Saito, Mitsuyuki Nakata, Shugo Komatsu, Satoru Oita, Yoshio Katsumata, Yukiko Saeda, Genta Ozeki, Yoshiteru Ohsone, Tomoro Hishiki

Erschienen in: Pediatric Surgery International | Ausgabe 2/2021

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Abstract

Purpose

The optimal timing of surgery for congenital diaphragmatic hernia (CDH) is controversial. We aimed to validate our protocol for the timing of CDH repair using the quantified patent ductus arteriosus (PDA) flow pattern.

Methods

This retrospective comparative study analyzed patients with a prenatal diagnosis of isolated CDH between 2007 and 2020. We defined the “LR ratio” as the percentage of velocity–time integral (VTI) of the left-to-right flow of PDA against overall VTI on echocardiography. Since 2010, we followed the decision criterion of performing surgery when LR ratio of > 50% has been achieved in the patients (protocol group). The protocol group (2010–2020) was compared with the historical control group (2007–2009).

Results

The average age at surgery was 104.1 ± 175.9 and 37.3 ± 30.6 h in the control and protocol groups, respectively (p = 0.11). Survival rate (88.9% vs. 95.0%, p = 0.53) and the rate of worsening of pulmonary hypertension within 24 h after surgery (22.2% vs. 10.0%, p = 0.57) were not different between the groups. The protocol group had a significantly shorter duration of tracheal intubation (26.9 ± 21.1 vs. 13.3 ± 9.5 days, p = 0.03).

Conclusion

Our decision criterion might have the advantage of facilitating early and safe surgery for patients with CDH.

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Titel: Optimization of surgical timing of congenital diaphragmatic hernia using the quantified flow patterns of patent ductus arteriosus
verfasst von: Yoshitaka Shinno
Keita Terui
Mamiko Endo
Takeshi Saito
Mitsuyuki Nakata
Shugo Komatsu
Satoru Oita
Yoshio Katsumata
Yukiko Saeda
Genta Ozeki
Yoshiteru Ohsone
Tomoro Hishiki
Publikationsdatum: 03.01.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 2/2021
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-020-04788-9

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Optimization of surgical timing of congenital diaphragmatic hernia using the quantified flow patterns of patent ductus arteriosus