Early post-operative hemodynamic recovery in infants with congenital diaphragmatic hernia.

Abstract

Pulmonary hypertension and cardiac dysfunction contribute to morbidity in infants with congenital diaphragmatic hernia (CDH). Although surgical repair relieves thoracic compression, post-repair hemodynamic recovery remains incompletely understood. We aimed to characterize changes in ventricular function and pulmonary hypertension indices using paired echocardiography. This retrospective cohort study included 52 infants with CDH who underwent echocardiographic assessments 24 h before and 24-48 h after surgical repair. Paired analyses were performed for the continuous and categorical variables. Predefined abnormal thresholds were applied to assess post-repair normalization. Associations between changes in pulmonary hypertension markers and ventricular function were examined using correlation analysis. Significant improvements were observed in echocardiographic measures following repair. Ejection fraction increased from 62 to 72%, and tricuspid annular plane systolic excursion (TAPSE) increased from 7 to 12 mm (all p < 0.001). The right ventricular systolic pressure decreased from 30 to 24 mmHg, and the eccentricity index improved from 1.2 to 1.1 (both p < 0.001). Normal septal morphology was restored in 58.3% of infants, and right-to-left ductal shunting resolved in all affected cases. Reductions in the eccentricity index correlated with improvements in left ventricular output (ρ = - 0.31, p = 0.024), left ventricular longitudinal strain (ρ = 0.43, p = 0.005), TAPSE (ρ = 0.37, p = 0.006), and right ventricular output (ρ = - 0.37, p = 0.007).

Conclusion:  Surgical repair of CDH is associated with early postoperative changes in echocardiographic indices of biventricular systolic performance and pulmonary vascular loading. Paired echocardiography allows quantification of early hemodynamic adaptation following repair.

What is known: • Pulmonary hypertension and ventricular dysfunction are major contributors to early morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). • The early hemodynamic impact of surgical repair, assessed using paired preoperative and postoperative echocardiography within individual infants, has not been well characterized.

What is new: • Surgical repair of CDH is associated with early postoperative changes in echocardiographic indices of biventricular systolic performance, septal geometry, and pulmonary hypertension. • Changes in pulmonary vascular loading were closely associated with directional changes in ventricular systolic performance indices, highlighting the importance of ventricular-vascular interaction in early postoperative hemodynamic adaptation.