(1019) Mediastinal Shift Angle and its association with perinatal mortality and lung volumes in CDH fetuses

Friday, January 31, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Edgar A. Hernandez-Andrade, MD, PhD (he/him/his)

Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Coauthor(s)

DG

Donatella Gerulewicz Vannini

University of Texas Health Science Center in Houston, McGovern Medical School
Houston, Texas, United States
KH

Katrina S. Hughes, MD

Assistant Professor
McGovern Medical School. UThealth Houston
Houston, Texas, United States
Sami Backley, MD

Clinical Fellow PGY 9
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
JR

Jerrie Refuerzo, MD

Associate Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Jimmy Espinoza, MD, MSc

Professor
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Eric P. Bergh, MD

Associate Professor
Nemours Children's Health
Wilmington, Delaware, United States
Percy N. Pacora-Portella, MD, MPH (he/him/his)

Associate Professor
Division of Fetal Intervention, Dpt Obstetrics,Gynecol and Reprod Sciences, McGovern Medical School at UTHealth Houston
Houston, TX, United States
GV

Gustavo Vilchez, MD, MSCR

UTHealth Houston
Houston, Texas, United States
Ramesha Papanna, MD, MPH

Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Anthony Johnson, DO

Professor
McGovern Medical School University of Texas Health Science Center at Houston (UThealth)
Houston, Texas, United States

Objective: The mediastinal shift angle (MSA) has been proposed as a potentially useful marker for the identification of CDH fetuses at risk of perinatal death. We aimed to evaluate the predictive performance of MSA for perinatal mortality in fetuses with isolated left CDH, particularly among those considered as mild and moderate with an O/E LHR (observed/expected lung-to-head ratio) >25%, and its correlation with other metrics of CDH severity.

Study Design:

MSA was measured in a cross-sectional image of the fetal thorax in 84 fetuses with left CDH. MSA was obtained from two lines starting from a common point in the skin at the midline of the back of the spine, the first line dividing the thorax into two halves, and a second line directed to the lateral border of the right atrium (Fig 1). The MSA becomes wider as the right atrium is displaced towards the right side of the thorax. Additionally, the O/E LHR and MRI assessment of O/E total fetal lung volume (TFLV), and percentage of liver herniation (%LH) were evaluated. ROC analysis, prediction, and association with perinatal mortality and correlations with the mentioned predictors were evaluated

Results:

Perinatal mortality was 31.3% (26/83). The areas under the ROC curve for perinatal mortality for MSA and O/E LHR were 0.694 and 0.753, respectively (p=0.2). MSA best cut-off value was 35° with 77% sensitivity, and 38% 1-specificity; OR 6.68 (95% CI 2.2-21.3; p < 0.001), adjusted aOR 8.9 (95% CI 1.2-59.7; p=0.02). Among fetuses with O/E LHR > 25% (n=60) mortality was 21% (n=13), MSA ≥ 35° showed an AUROC = 0.691 with 75% sensitivity and 36% 1-specificity, aOR 5.29 (1.47-19.01; p=0.01). There was a significant correlation between MSA and O/E LHR (-0.48, p < 0.001), O/E TFLV (-0.36, p=0.005), and %LH (0.43, p=0.001).

Conclusion: The MSA angle is a technically simple and feasible metric to evaluate severity and risks for perinatal mortality in left-sided CDH cases. An MSA ≥ 35° can identify 77% of cases at increased risk of perinatal mortality. The prediction performance is similar among fetuses with moderate or mild CDH