Pediatric Cardiology

, Volume 39, Issue 5, pp 993–1000 | Cite as

Diminished Cardiac Performance and Left Ventricular Dimensions in Neonates with Congenital Diaphragmatic Hernia

  • Gabriel Altit
  • Shazia Bhombal
  • Krisa Van Meurs
  • Theresa A. Tacy
Original Article



Newborns with congenital diaphragmatic hernia (CDH) have varying degrees of pulmonary hypoplasia and pulmonary hypertension (PH), and there is limited evidence that cardiac dysfunction is present. We sought to study early neonatal biventricular function and performance in these patients by reviewing early post-natal echocardiography (ECHO) measurements and comparing them to normal term newborns.


Retrospective case–control study reviewing clinical and ECHO data on term newborns with CDH and normal controls born between 2009 and 2016. Patients were excluded if major anomalies, genetic syndromes, or no ECHO available. PH was assessed by ductal shunting and tricuspid regurgitant jet velocity. Speckle-tracking echocardiography was used to assess myocardial deformation using velocity vector imaging.


Forty-four patients with CDH and 18 age-matched controls were analyzed. Pulmonary pressures were significantly higher in the CDH cohort (systolic pulmonary arterial pressure to systolic blood pressure of 103 ± 13 vs. 78 ± 29%, p = 0.0001). CDH patients had decreased RV fractional area change (FAC − 28.6 ± 11.1 vs. 36.2 ± 9.6%, p = 0.02), tricuspid annular plane of systolic excursion (TAPSE—5.6 ± 1.6 vs. 8.6 ± 1.6 mm, p = 0.0001), and RV outflow tract stroke distance (8.6 ± 2.7 vs. 14.0 ± 4.5 cm, p = 0.0001) compared with controls. The left ventricular (LV) ejection fraction was similar in both groups, but CDH patients had a decreased LV end-diastolic volume by Simpson’s rule (2.7 ± 1.0 vs. 5.0 ± 1.8 mL, p = 0.0001) and LVOT stroke distance (9.7 ± 3.4 vs. 12.6 ± 3.6 cm, p = 0.004). Biventricular global longitudinal strain (GLS) was markedly decreased in the CDH population compared to controls (RV-GLS: − 9.0 ± 5.3 vs. − 19.5 ± 1.4%, p = 0.0001; LV GLS: − 13.2 ± 5.8 vs. − 20.8 ± 3.5%, p = 0.0001).


CDH newborns have evidence of biventricular dysfunction and decreased cardiac output. Abnormal function may be a factor in the non-response to pulmonary arterial vasodilators in CDH patients. A two-pronged management strategy aimed at improving cardiac function, as well as reducing pulmonary artery pressure in CDH newborns, may be warranted.


Speckle-tracking echocardiography Congenital diaphragmatic hernia Neonatal cardiac function Pulmonary hypertension Strain analysis Velocity vector imaging 



Blood pressure


Congenital diaphragmatic hernia


Digital imaging and communications in medicine format


Early diastolic strain rate


Ejection fraction


End-diastolic volume


Extracorporeal membrane oxygenation


Fractional area change


Global longitudinal strain


Global longitudinal strain rate


Left ventricle


Eccentricity index


Left ventricular outflow tract


Main pulmonary artery


Patent ductus arteriosus


Pulmonary artery pressure


Right ventricle


Right ventricular outflow tract


Speckle-tracking echocardiography


Standard deviation


Tricuspid annular plane systolic excursion


Tricuspid regurgitant jet velocity


Velocity time integral


Velocity vector imaging


Compliance with Ethical Standards

Conflict of interest

We have no conflicts of interest related to the content of this study. Gabriel Altit is the author that wrote the first draft. There was no payment, grant, or honorarium given to anyone to produce the manuscript.

Ethical Approval

This study was approved by the institutional review board of Stanford University (protocol—IRB-39501).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Neonatology, Department of PediatricsMcGill University – Montreal Children’s HospitalMontrealCanada
  2. 2.Division of Neonatal and Developmental Medicine, Department of PediatricsStanford University School of MedicineStanfordUSA
  3. 3.Neonatal ECMO ProgramLucile Packard Children’s Hospital at StanfordStanfordUSA
  4. 4.Division of Cardiology, Echocardiography Laboratory, Department of PediatricsStanford University - Lucile Packard Children’s HospitalStanfordUSA

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