LV hypoplasia and dysfunction in CDH


Case 1

Initial ECHO:

Mild to moderate mitral regurgitation in the apical 4 chamber view

Some degree of LV dysfunction in A4C

Moderate dysfunction in the A2C

Depressed Ejection fraction by Speckle Tracking echocardiography

Abnormal strain (deformation) using speckle tracking echocardiography for the LV. 

CDH repaired at DOL4. TnECHO repeated post-OR DOL6:

RV dilation and bowing of the septum in systole towards the left ventricle indicating supra-systemic pulmonary pressure. 

RV dilation by 3D echocardiography

Restrictive ductus that is bidirectional. Right to left in systole with estimated PA to Ao gradient of 33 mmHg

TR indicating supra-systemic pulmonary arterial pressure 94 mmHg of RV-RA gradient, for sBP at the time of the ECHO at around 60 mmHg. 

Following the introduction of iNO during the ECHO, the RV decompressed, the PDA became predominantly left to right and the TR decreased to 50 mmHg. 

Case 2

Initial Echo

PFO is bidirectional but mostly left to right

Septal flattening/bowing.

Restrictive ductus - bidirectional 

TR with RV-RA gradient of about 100 mmHg

Bidirectional PDA with right to left gradient in systole of 30 mmHg. 

After PGE and Milrinone - ECHO

PDA is now large and bidirectional - not restrictive, with minimal gradient right to left in systole). Allows to pop-off the RV and maintain LV output. 

Adequate RV and LV function. The RV is less dilated. 

The PFO is now only left to right. 

Septum is round at peak of systole and RV is decompressed. 

Created by Gabriel Altit - Neonatologist / Créé par Gabriel Altit (néonatalogiste) - © NeoCardioLab - 2020-2023 - Contact us / Contactez-nous