{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:20:19Z","timestamp":1790814019290,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,11,9]],"date-time":"2015-11-09T00:00:00Z","timestamp":1447027200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2015,12]]},"abstract":"ABSTRACT<\/jats:title>Objectives<\/jats:title>To assess whether severity of congenital diaphragmatic hernia (CDH<\/jats:styled-content>) correlates with the degree of left heart hypoplasia and left ventricle (LV<\/jats:styled-content>) output, and to determine if factors leading to abnormal fetal hemodynamics, such as compression and reduced LV<\/jats:styled-content> preload, contribute to left heart hypoplasia.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was a retrospective cross\u2010sectional study of fetuses at 16\u201337 weeks' gestation that were diagnosed with CDH<\/jats:styled-content> between 2000 and 2010. Lung\u2010to\u2010head ratio (LHR<\/jats:styled-content>), liver position and side of the hernia were determined from stored ultrasound images. CDH<\/jats:styled-content> severity was dichotomized based on LHR<\/jats:styled-content> and liver position. The dimensions of mitral (MV<\/jats:styled-content>) and aortic (AV<\/jats:styled-content>) valves and LV<\/jats:styled-content> were measured, and right and left ventricular outputs were recorded.<\/jats:p><\/jats:sec>Results<\/jats:title>In total, 188 fetuses with CDH<\/jats:styled-content> were included in the study, 171 with left CDH<\/jats:styled-content> and 17 with right CDH<\/jats:styled-content>. Fetuses with severe left CDH<\/jats:styled-content> had a smaller MV<\/jats:styled-content> (Z<\/jats:italic>\u2009=\u2009\u20132.24\u2009\u00b1\u20091.3 vs<\/jats:italic> \u20131.33\u2009\u00b1\u20091.08), AV<\/jats:styled-content> (Z<\/jats:italic>\u2009=\u2009\u20131.39\u2009\u00b1\u20091.21 vs<\/jats:italic> \u20130.51\u2009\u00b1\u20091.05) and LV<\/jats:styled-content> volume (Z<\/jats:italic>\u2009=\u2009\u22124.23\u2009\u00b1\u2009\u22122.71 vs<\/jats:italic> \u22122.08\u2009\u00b1\u20093.15) and had lower LV<\/jats:styled-content> output (26\u2009\u00b1\u200910% vs<\/jats:italic> 32\u2009\u00b1\u200910%) than those with mild CDH<\/jats:styled-content>. MV<\/jats:styled-content> and AV<\/jats:styled-content> in fetuses with right CDH<\/jats:styled-content> (MV<\/jats:styled-content>, Z\u2009=\u2009\u2013<\/jats:italic>0.83\u2009\u00b1\u20091.19 and AV<\/jats:styled-content>, Z\u2009=\u2009\u2013<\/jats:italic>0.71\u2009\u00b1\u20091.07) were larger than those in fetuses with left CDH<\/jats:styled-content>, but LV<\/jats:styled-content> outputs were similarly diminished, regardless of hernia side. Severe dextroposition and abnormal liver position were associated independently with smaller left heart, while LHR<\/jats:styled-content> was not.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>The severity of left heart hypoplasia correlates with the severity of CDH<\/jats:styled-content>. Altered fetal hemodynamics, leading to decreased LV<\/jats:styled-content> output, occurs in both right\u2010 and left\u2010sided CDH<\/jats:styled-content>, but the additional compressive effect on the left heart is seen only when the hernia is left\u2010sided. Improved knowledge of the physiology of this disease may lead to advances in therapy and better risk assessment for use in counseling affected families. Copyright \u00a9 2015 ISUOG. Published by John Wiley & Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.14790","type":"journal-article","created":{"date-parts":[[2015,1,19]],"date-time":"2015-01-19T10:55:58Z","timestamp":1421664958000},"page":"688-694","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":76,"title":["Severe left diaphragmatic hernia limits size of fetal left heart more than does right diaphragmatic hernia"],"prefix":"10.1002","volume":"46","author":[{"given":"F. A.","family":"Byrne","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Divisions of Cardiology University of California, Benioff Children's Hospital San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. L.","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology University of California, Benioff Children's Hospital San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Meadows","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Divisions of Cardiology University of California, Benioff Children's Hospital San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Miniati","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Pediatric Surgery University of California San Francisco CA USA"},{"name":"Fetal Treatment Center University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. M.","family":"Brook","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Divisions of Cardiology University of California, Benioff Children's Hospital San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. H.","family":"Silverman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Divisions of Cardiology University of California, Benioff Children's Hospital San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. J.","family":"Moon\u2010Grady","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Divisions of Cardiology University of California, Benioff Children's Hospital San Francisco CA USA"},{"name":"Fetal Treatment Center University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,11,9]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(97)90183-4"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(84)80105-0"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7497"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7693"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)83293-7"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2010.196550"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-5108(18)30210-0"},{"key":"e_1_2_6_9_1","doi-asserted-by":"crossref","first-page":"10062","DOI":"10.1007\/s001340050457","article-title":"Congenital diaphragmatic hernia: Antenatal prognostic factors. 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