Integrated Prenatal Cardiopulmonary Assessment Using Fetal Echocardiography in Isolated Left-Sided Congenital Diaphragmatic Hernia
In brief
Mitral-to-tricuspid valve ratio best predicted survival in left-sided fetal hernia
In 363 fetuses with isolated left-sided congenital diaphragmatic hernia, overall survival was 74.9%, and the mitral-to-tricuspid valve ratio was the strongest echocardiographic predictor of survival, with moderate accuracy. An exploratory model combining this ratio with lung size and liver position performed better in fetuses assessed by 29 weeks, but it needs external validation before clinical use.
- Journal
- Prenatal diagnosis (Q1)
- Published
- 7 November 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Masaya Yamoto, Noboru Inamura, Katsuaki Toyoshima, Keita Terui, Kouji Nagata, Yoshiaki Sato, et al.
- PMID
- 42998300
- DOI
- 10.1002/pd.70298
Why clinicians should know about it
- Picked for Pediatric Surgery (paper of the day, 9 November 2026): Prenatal survival prognostication for congenital diaphragmatic hernia
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.