Difficulties in the Hemodynamic Assessment of the Newborn with Prenatally Treated Congenital Diaphragmatic Hernia.

[congenital diaphragmatic hernia]

Congenital diaphragmatic hernia (CDH ) is a malformation with a diverse clinical picture . Its severity can be assessed prenatally using the lung area to head circumference ratio (LHR ). LHR lower than 1 as associated with high mortality is an indication for prenatal treatment involving occlusion of fetal trachea . Before such treatment other congenital malformations must be excluded . Assessment of circulatory system in these patients is difficult . Heart is compressed by viscera in the thorax that decreases blood return to the left atrium , and structures of the left heart may be smaller than in healthy fetuses . The echocardiographic picture may be similar to some congenital defects of the left heart . Differentiation between structural and functional cardiac abnormalities is difficult but essential for diagnostic and therapeutic decisions in the most severe type of CDH . The authors present problems with interpretation of hemodynamic disturbances in a neonate with prenatally diagnosed and treated severe CDH .