Left ventricular hypoplasia in congenital diaphragmatic hernia

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Quantitative anatomic study of the hearts of eight infants with left-sided congenital diaphragmatic hernia (CDH) has revealed significantly decreased cardiac mass, due to hypoplasia of the left atrium and ventricle and interventricular septum. These morphologic deficiencies may be a result of compression of mediastinal structures by herniated abdominal viscera during prenatal life. Left ventricular hypoplasia is likely to be an important factor in the pathogenesis of cardiac insufficiency in patients with left CDH.

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    This parameter appears to be independently predictive of postnatal outcome in CDH, and may augment the prognostic value of established measures of fetal lung volume [26]. Changes in the fetal pulmonary vasculature are accompanied by relative hypoplasia of the heart, particularly the left ventricle [27,28]. LV hypoplasia is characterized by narrowing and elongation of the ventricle and is associated with a reduction in fetal left ventricular output [29,30].

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From the Department of Laboratories, Children's Orthopedic Hospital and Medical Center, and Departments of Pathology and Pediatrics, University of Washington, Seattle, Washington.

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