Pulmonary artery diameter ratio as a prognostic indicator of congenital diaphragmatic hernia

Background Following on from an earlier study published in 2008 about left pulmonary artery(LPA)flow measured on serial echocardiography being strongly prognostic in left-sided congenital diaphragmatic hernia(CDH)and the ratio of LPA to right pulmonary artery(RPA)diameters being a simple and reliable indicator for commencing nitric oxide(NO)therapy,the ratio of LPA:RPA diameters(PA ratio orPAR)was hypothesized to possibly reflect cardiopulmonary stresses accompanying CDH better.Methods Subjects with isolated left-sided CDH treated between 2007 and 2020 at a single pediatric surgical center were recruited and classified according to survival.Data obtained retrospectively for subject demographics,clinical course,LPA/RPA diameters,and PAR were compared between survivors and non-survivors.The value of PAR for optimizing the prognostic value of PA diameter data in CDH were analyzed with receiver operating characteristic(ROC)curve analysis.Results Of 65 subjects,there were 54 survivors(82.3%)and 11 non-survivors(17.7%);7 of 11 non-survivors died before surgical repair could be performed.Mean PAR for survivors(0.851±0.152)was significantly higher than for non-survivors(0.672±0.108)(p=0.0003).Mean PAR for non-survivors was not affected by surgical repair.Characteristics of survivors were:LPA≥2 mm(n=52 of 54;mean PAR=0.866±0.146)and RPA≥3mm(n=46 of 54;mean PAR=0.857±0.152).Non-survivors with similar LPA and RPA diameters to survivors had significantly lower mean PAR.ROC curve cut-off for PAR was 0.762.Subjects with high PAR(≥0.762)required high-frequency oscillatory ventilation/NO less than subjects with low PAR(<0.762)(p=0.0244 and p=0.0485,respectively)and subjects with high PAR stabilized significantly earlier than subjects with low PAR(1.71±0.68 days vs 3.20±0.87 days)(p<0.0001).Conclusions PAR would appear to be strongly correlated with clinical outcome in CDH and be useful for planning management of cardiopulmonary instability in CDH.

Kidney structure and function in dilating vesicoureteral reflux patients with anorectal malformation

Background We assessed the impact of anorectal malformation(ARM)on the kidneys of children with dilating vesicoureteral reflux(D-VUR)≥grade III using a simple dimercaptosuccinic acid(DMSA)scintigraphy scan based renal dysfunction score(RDS).Methods The medical records of 121 patients with D-VUR treated between 2000 and 2014 were reviewed retrospectively.After excluding patients with secondary D-VUR(n=18),presence of ARM was used to create two groups:ARM+(n=12 cases;15 ureters)and ARM-(n=91 cases;131 ureters).Types of ARM,grades of D-VUR,bladder and bowel dysfunction(BBD)and RDS were compared.Results Patient demographics,mean follow-up,grades of D-VUR and history of urinary tract infections were not significantly different.BBD was significantly higher in ARM+(41.7%versus 7.7%,p=0.0006).RDS was significantly higher in ARM+(p=0.036).Grades of D-VUR were significantly lower in ARM-with low RDS(p=0.008).During follow-up,changes in DMSA uptake over time were not observed in ARM+.Conclusions While renal cortical lesions were correlated with grade of D-VUR in ARM-and RDS was significantly higher in ARM+,BBD did not appear to contribute to progressive renal dysfunction as is commonly believed.In fact,no progression in renal cortical lesions was observed in ARM+based on RDS data.Renal cortical lesions may possibly be a feature of ARM,a topic that warrants further study.

Use of transabdominal (external) ultrasound during balloon dilatation to diagnose tracheobronchial remnant in congenital esophageal stenosis

Preoperativedifferential diagnosis between tracheobronchial remnant(TBR)and other typesof congenital esophageal stenosis(CES)is challenging,even when usingendoscopic ultrasonography(EUS).This report is the first to demonstrate theuse of transabdominal(external)ultrasound during balloon dilatation todiagnose TBR in CES.This simple technique is a promising diagnostic tool forTBR as an alternative to EUS.