Cardiac morphology in children at 2 and 10 years of age after congenital diaphragmatic hernia repair: a comparative MRI-based analysis of ECMO and non-ECMO patients.

objectivesCongenital diaphragmatic hernia (CDH) is a diaphragmatic defect causing lung hypoplasia and frequently resulting in pulmonary arterial hypertension (PAH), associated with high morbidity and mortality. This retrospective study aimed to assess differences in cardiac morphology between ECMO and non-ECMO patients after CDH repair and to evaluate their temporal association with the development of PAH at two and ten years of age. MATERIALS AND

methodsIn this retrospective study, MRI data from 57 children after CDH repair were analyzed. Patients were divided into two groups: children receiving ECMO therapy (n = 31) and children without ECMO therapy (n = 26). Morphological parameters, including the pulmonary artery to aorta ratio (PA/Ao), right to left ventricle ratio (RV/LV), and the eccentricity index (EI), were measured at two and ten years. Group differences were assessed using independent-samples t-tests, and binary logistic regression was applied. Boxplots visualized parameter distributions.

resultsECMO-treated patients showed significantly higher EI and RV/LV ratios at two years. The PA/Ao ratio showed no significant difference between groups at this time point. At ten years of age, none of the measured cardiac parameters differed significantly between ECMO and non-ECMO patients. Logistic regression identified ECMO therapy as an independent predictor of elevated EI at two years (OR = 7.68, 95% CI: 1.93-30.47, p = 0.004).

conclusionThese findings suggest that ECMO-treated children after CDH repair exhibit early signs of persistent pulmonary hypertension, as reflected by elevated EI values at two years. The normalization of cardiac parameters by ten years may indicate pulmonary vascular adaptation over time. KEY POINTS: Question Identifying long-term cardiac alterations after CDH repair is essential for understanding the persistence of pulmonary hypertension, particularly in patients requiring ECMO therapy. Findings Cardiac MRI revealed higher EI and RV/LV ratio in ECMO-treated children at two years, indicating persistent pulmonary hypertension, which normalized by ten years. Clinical relevance Early detection of cardiac remodeling in ECMO-treated CDH survivors enables closer cardiovascular follow-up and may guide timely interventions to support pulmonary vascular adaptation and long-term cardiac health.