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Prenatal Prediction Of Pulmonary Arterial Hypertension In Congenital Diaphragmatic Hernia.
[congenital diaphragmatic hernia]
To
evaluate
the
relevance
of
routinely
prenatal
prognostic
markers
as
side
of
the
defect
,
liver
position
,
lung
-
to
-
head
ratio
(
LHR
)
,
observed
/
expected
lung
-
to
-
head
ratio
(
o
/
e-
LHR
)
and
observed
/
expected
total
fetal
lung
volume
(
o
/
e-
TFLV
)
at
magnetic
resonance
imaging
to
predict
the
development
of
postnatal
pulmonary
arterial
hypertension
(
PAH
)
in
isolated
congenital
diaphragmatic
hernia
(
CDH
)
.
110
isolated
CDH
were
referred
to
our
fetal
medicine
unit
between
January
2004
and
April
2013
.
Mortality
and
morbidity
were
reviewed
according
to
the
presence
of
postnatal
PAH
.
The
following
prenatal
markers
were
evaluated
as
potential
predictive
factors
of
PAH
:
liver
position
,
side
of
the
defect
,
LHR
and
o
/
e-
LHR
measured
by
ultrasound
,
o
/
e-
TFLV
measured
by
magnetic
resonance
imaging
.
Univariate
logistic
regression
was
used
to
measure
association
.
PAH
was
significantly
associated
with
perinatal
mortality
and
morbidity
(
P
 
<
 
0
.
001
)
.
The
occurrence
of
PAH
significantly
decreased
with
increasing
LHR
,
o
/
e-
LHR
and
o
/
e-
TFLV
,
while
significantly
increased
with
intra-
thoracic
liver
,
but
not
in
right
-sided
defects
.
Univariate
regression
found
o
/
e-
TFLV
(
OR
=
0
.
9
[
0
.
86
-
0
.
95
]
P
 
<
 
0
.
05
for
percentage
unit
change
in
o
/
e
)
,
LHR
(
OR
=
0
.
19
[
0
.
09
-
0
.
40
]
P
 
<
 
0
.
05
per
unit
change
)
,
o
/
e-
LHR
(
OR
=
0
.
95
[
0
.
93
-
0
.
98
]
P
 
<
 
0
.
05
for
percentage
unit
change
in
o
/
e
)
,
liver
location
(
OR
=
2
.
82
[
1
.
13
-
7
]
P
 
<
 
0
.
05
for
liver
up
)
were
significant
predictors
of
subsequent
PAH
.
No
differences
were
found
after
adjusting
for
gestational
age
at
delivery
.
The
area
under
the
ROC
curve
was
0
.
80
and
0
.
75
for
o
/
e-
TFLV
and
o
/
e-
LHR
respectively
.
In
CDH
,
PAH
is
associated
with
a
high
rate
of
mortality
and
morbidity
.
Routinely
prenatal
markers
usually
used
for
the
assessment
of
pulmonary
hypoplasia
are
also
relevant
for
postnatal
prediction
of
PAH
.
Diseases
Validation
Diseases presenting
"hypertension"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
aniridia
aromatase deficiency
cadasil
child syndrome
cohen syndrome
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cushing syndrome
cystinuria
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
fabry disease
familial hypocalciuric hypercalcemia
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kallmann syndrome
kindler syndrome
lamellar ichthyosis
lymphangioleiomyomatosis
pendred syndrome
primary effusion lymphoma
scrub typhus
severe combined immunodeficiency
sneddon syndrome
typhoid
von hippel-lindau disease
well-differentiated liposarcoma
werner syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated