Abstract
Five cases with congenital diaphragmatic hernia who developed symptoms within the 1st 24 hours were reviewed. The value of the AaO_2 measured on admission was 570mmHg on the average. The difference in p02 between the right radial artery and the arteria dorsalis pedis (hereafter abbreviated as PPD) was examined. The PPD within 15 hours after birth were more than 30mmHg in all five cases and in four the PPD dissappeared within three days after birth. The real-time two-dimentional doppler echocardiography by use of an autocorrelator with a high speed calculator and a color processor (hereafter abbreviated as CD-Echo) was examined. CD-Echo showed the enlargement of the right atrium and the right ventricle, the shunting through the ductus arteriosus or the foramen ovale and significant tricuspid regurgitation in all five cases. By modified Bernoulli equation maximal systolic pressure gradient between the right ventricle and the right atrium (hereafter abbreviated as ⊿P) can be estimated by the peak flow velocity of the tricuspid regurgitant jet. When the pulumonary valve or the outflow of the right ventricle are not stenotic, pulmonary arterial pressure can be conjectured by the value of the ⊿P. Transition of the shunting and ⊿P was coincident with clinical course. If the value of the ⊿P does not declined, it is necessary to research and treat the cause of persistent pulmonary hypertension. The importance of this observation for new born infants with severe congenital diaphragmatic hernia is that a reliable, noninvasive technique exsists for estimating ⊿P and, by inference, PA pressure and through this finding the effective therapeutic manipulations based on the infant's hemodynamic state can be made.
