Integrated Prenatal Cardiopulmonary Assessment Using Fetal Echocardiography in Isolated Left‐Sided Congenital Diaphragmatic Hernia

OBJECTIVE: Prenatal severity assessment in congenital diaphragmatic hernia (CDH) primarily relies on lung-based parameters such as the observed-to-expected lung-to-head ratio (o/eLHR) and liver position; however, these markers do not fully reflect fetal cardiopulmonary adaptation. We investigated the prognostic significance of fetal echocardiographic parameters and integrated these in prenatal prediction models in left-sided CDH. METHODS: This nationwide multicenter retrospective study included fetuses with prenatally diagnosed isolated left-sided CDH. Gestational age-adjusted Z-scores were generated for fetal cardiac dimensions. Receiver operating characteristic analyses were performed to evaluate prognostic performance for survival. RESULTS: A total of 363 fetuses were included, with an overall survival rate of 74.9%. Non-survivors demonstrated significantly smaller right pulmonary artery and mitral valve dimensions than survivors. Among fetal echocardiographic parameters, the mitral-to-tricuspid valve ratio (MTR) demonstrated the strongest predictive performance, with an area under the curve (AUC) of 0.77. In fetuses evaluated at ≤ 29 weeks' gestation, an exploratory model combining MTR with o/eLHR and liver-up status achieved an apparent AUC of 0.827. CONCLUSION: Fetal echocardiographic parameters were associated with survival in CDH. Integrated prenatal cardiopulmonary assessment incorporating MTR may provide complementary prognostic information although independent external validation is required.

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Journal
Prenatal Diagnosis
Published
2026-11-07
DOI
https://doi.org/10.1002/pd.70298
Primary Topic
Congenital Diaphragmatic Hernia Studies
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article
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article

Integrated Prenatal Cardiopulmonary Assessment Using Fetal Echocardiography in Isolated Left‐Sided Congenital Diaphragmatic Hernia

Yuhki Koike, Yuta Yazaki, Yasunori Sato, Kiyokazu Kim et al.
Prenatal Diagnosis
Congenital Diaphragmatic Hernia Studies
article

Integrated Prenatal Cardiopulmonary Assessment Using Fetal Echocardiography in Isolated Left‐Sided Congenital Diaphragmatic Hernia

Yuhki Koike, Yuta Yazaki, Yasunori Sato, Kiyokazu Kim, Hiroomi Okuyama, Katsuaki Toyoshima, Kouji Nagata, Tadaharu Okazaki, Keita Terui, Noboru Inamura, Hidehiko Maruyama, Masaya Yamoto, Akiko Yokoi, Yunosuke Kawaguchi, Noriaki Usui, Yoshiaki Sato, Kouji Masumoto
article en

Abstract

OBJECTIVE: Prenatal severity assessment in congenital diaphragmatic hernia (CDH) primarily relies on lung-based parameters such as the observed-to-expected lung-to-head ratio (o/eLHR) and liver position; however, these markers do not fully reflect fetal cardiopulmonary adaptation. We investigated the prognostic significance of fetal echocardiographic parameters and integrated these in prenatal prediction models in left-sided CDH. METHODS: This nationwide multicenter retrospective study included fetuses with prenatally diagnosed isolated left-sided CDH. Gestational age-adjusted Z-scores were generated for fetal cardiac dimensions. Receiver operating characteristic analyses were performed to evaluate prognostic performance for survival. RESULTS: A total of 363 fetuses were included, with an overall survival rate of 74.9%. Non-survivors demonstrated significantly smaller right pulmonary artery and mitral valve dimensions than survivors. Among fetal echocardiographic parameters, the mitral-to-tricuspid valve ratio (MTR) demonstrated the strongest predictive performance, with an area under the curve (AUC) of 0.77. In fetuses evaluated at ≤ 29 weeks' gestation, an exploratory model combining MTR with o/eLHR and liver-up status achieved an apparent AUC of 0.827. CONCLUSION: Fetal echocardiographic parameters were associated with survival in CDH. Integrated prenatal cardiopulmonary assessment incorporating MTR may provide complementary prognostic information although independent external validation is required.

Prenatal Diagnosis
Kyushu University (JP), University of Tsukuba (JP), Jichi Medical University (JP), Chiba University (JP), Mie University (JP), Keio University (JP), Juntendo University (JP), Kyoto Prefectural University of Medicine (JP), Nagoya University Hospital (JP), Osaka Women's and Children's Hospital (JP), Osaka City General Hospital (JP), Kanagawa Children's Medical Center (JP), Kobe Children's Hospital (JP), National Center For Child Health and Development (JP), Juntendo University Urayasu Hospital (JP), Juntendo University Hospital (JP), Shizuoka Children's Hospital (JP), Kindai University (JP), The University of Osaka (JP)
Good health and well-being
Openalex Percentile: Top 12%
Congenital Diaphragmatic Hernia Studies
DOIOpen Access PDFOpenAlex
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