Learning Curve for Intrapulmonary Artery Doppler in Fetuses with Congenital Diaphragmatic Hernia

Objective: To assess the learning curve for intrapulmonary artery Doppler in fetuses with congenital diaphragmatic hernia (CDH). Methods: Three fetal medicine fellows with the theoretic knowledge, but without prior experience, in the evaluation of intrapulmonary artery Doppler in CDH fetuses were selected. Each trainee and 1 experienced explorer assessed the intrapulmonary artery in the contralateral lung to the side of the hernia for calculation of 2 Doppler parameters - pulsatility index (PI) and peak early diastolic reversed flow (PEDRF) - in a cohort of 90 consecutive CDH fetuses. The average difference between the 3 trainees and the expert was calculated. A difference below 15% was considered as accurate measurement. The average learning curve was delineated using the cumulative sum analysis (CUSUM). Results: Among the total 270 intrapulmonary artery Doppler measurements performed by the 3 trainees, the number of failed examinations was 14 (15.6%) and 16 (17.8%) for PI and PEDRF, respectively. The CUSUM plots demonstrate that the learning curve was achieved by 53 and 63 tests performed for calculations of the intrapulmonary artery PI and PEDRF, respectively. Conclusion: Competence in Doppler evaluation of the intrapulmonary artery in CDH fetuses is achieved only after intensive continuous training.

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Learning Curve for Thoracoscopic Repair of Congenital Diaphragmatic Hernia Using Cumulative Sum Analysis

Advances in Pediatric Surgery ◽

10.13029/aps.2021.27.2.59 ◽

2021 ◽

Vol 27 (2) ◽

pp. 59

Author(s):

Sang Woo Ha ◽

Suhyun Ha ◽

Hyunhee Kwon ◽

Dae Yeon Kim ◽

Jung-Man Namgoong

Keyword(s):

Learning Curve ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Cumulative Sum ◽

Cumulative Sum Analysis ◽

Thoracoscopic Repair

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Computed tomography based measurements to evaluate lung density and lung growth after congenital diaphragmatic hernia

Scientific Reports ◽

10.1038/s41598-021-84623-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Timm Stoll-Dannenhauer ◽

Gregor Schwab ◽

Katrin Zahn ◽

Thomas Schaible ◽

Lucas Wessel ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Contralateral Side ◽

Chest Ct ◽

Control Group ◽

P Value ◽

Lung Density ◽

Ipsilateral Lung ◽

Contralateral Lung ◽

Pediatric Chest

AbstractEmphysema-like-change of lung is one aspect of lung morbidity in children after congenital diaphragmatic hernia (CDH). This study aims to evaluate if the extent of reduced lung density can be quantified through pediatric chest CT examinations, if side differences are present and if emphysema-like tissue is more prominent after CDH than in controls. Thirty-seven chest CT scans of CDH patients (mean age 4.5 ± 4.0 years) were analyzed semi-automatically and compared to an age-matched control group. Emphysema-like-change was defined as areas of lung density lower than − 950 HU in percentage (low attenuating volume, LAV). A p-value lower than 0.05 was regarded as statistically significant. Hypoattenuating lung tissue was more frequently present in the ipsilateral lung than the contralateral side (LAV 12.6% vs. 5.7%; p < 0.0001). While neither ipsilateral nor contralateral lung volume differed between CDH and control (p > 0.05), LAV in ipsilateral (p = 0.0002), but not in contralateral lung (p = 0.54), was higher in CDH than control. It is feasible to quantify emphysema-like-change in pediatric patients after CDH. In the ipsilateral lung, low-density areas are much more frequently present both in comparison to contralateral and to controls. Especially the ratio of LAV ipsilateral/contralateral seems promising as a quantitative parameter in the follow-up after CDH.

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