EVALUATION OF LEFT-VENTRICULAR MASS IN CHILDREN WITH LEFT-SIDED CONGENITAL DIAPHRAGMATIC-HERNIA

To evaluate left ventricular (LV) mass in children with left-sided con genital diaphragmatic hernia (CDH), we retrospectively examined the ec hocardiographic data available on all newborn infants with a diagnosis of CDH between April 1989 and May 1993. Adequate data for evaluation were available for 20 of 31 patients with left-sided CDH and no signif icant congenital heart disease. Left ventricular mass was determined f rom two-dimensional echocardiograms by an area-length method. Findings were compared with a control group that consisted of neonates with ot her causes of pulmonary hypertension. Patients with left-sided CDH had a significantly lower indexed LV mass than control subjects (1.96 gm/ kg +/- 0.59 vs 2.84 gm/kg +/- 0.41; p = 0.0001). Additionally, childre n with left-sided CDH who required extracorporeal membrane oxygenation before repair (n = 7) had a significantly lower indexed LV mass than those patients who did not require extracorporeal membrane oxygenation before repair (1.53 gm/kg +/- 0.50 vs 2.20 gm/kg +/- 0.52; (p = 0.007 ). Infants who survived (n = 13) had an indexed LV mass of 2.09 gm/kg +/- 0.58 vs 1.64 gm/kg +/- 0.58 in those who died (p = 0.07). We concl ude that the LV mass index in children with left-sided CDH is signific antly lower than in children with other causes of pulmonary hypertensi on in the newborn period. Evaluation of LV mass in neonates with left- sided CDH may help predict the need for extracorporeal support before surgical repair, and may help indicate overall prognosis.