Fig. 5.

Cardiovascular effects of CDH – Hypoplastic lungs secondary to herniation of abdominal viscera leads to concomitant hypoplasia of the pulmonary vessels. This results in reduced blood supply to the hypoplastic alveolar-capillary unit. Once the infant transitions from fetal circulation, this effect is more pronounced resulting in pulmonary hypertension which leads to right ventricular dysfunction. Secondary to pulmonary hypertension, there is shunting of blood from right to left across the patent foramen ovale and the patent ductus arteriosus. Left ventricular dysfunction along with left atrial dysfunction results in pulmonary venous hypertension and worsening of pulmonary arterial hypertension. This presents clinically in a wide spectrum of labile pre & postductal saturations to profound cyanosis. (Copyright Satyan Lakshminrusimha)