Fetoscopic Endotracheal Occlusion for Severe Isolated Diaphragmatic Hernia: Initial Experience from a Single Clinic in Brazil

Abstract

Objective: To report on the initial experience in a single Brazilian university clinic of the use of fetoscopic endotracheal occlusion (FETO) to treat severe isolated congenital diaphragmatic hernia (CDH). Methods: The inclusion criteria for FETO for this prospective study were isolated CDH and intrathoracic herniation of the liver, as well as the lung area to head circumference ratio (LHR) <1.0. The main variables evaluated were LHR and observed to expected (o/e) LHR before and after FETO, gestational age (GA) at FETO, reversal of tracheal occlusion (TO), and birth and discharge of a living child from the hospital. Results: Among 8 isolated left-sided CDH cases with normal karyotypes, the median LHR and o/e LHR before FETO were 0.7 (range: 0.6–0.9) and 0.27 (range: 0.22–0.32), respectively. The median LHR and o/e LHR after FETO were 1.2 (range: 0.9–1.8) and 0.45 (0.31–0.67), respectively. The median GA at FETO, reversal of TO and birth were 26.8 (range: 26–29), 32.5 (range: 31.0–34.0) and 37 weeks (range: 35–37), respectively. Neonatal survival at the time of hospital discharge was 50% (4/8). Conclusion: FETO is feasible at our institution and may help to improve postnatal survival of children with severe CDH in developing countries.

Fetal Surgery for Congenital Diaphragmatic Hernia Is Back from Never Gone

“…In this issue of Fetal Diagnosis and Therapy , two larger case series from Brazil are also published. The reported outcomes of the study by Ruano et al [16] and Peralta et al [117] are quasi duplicates of what we reported ( table 1 ). …”

“…In recent years, it has become apparent that fetal intervention can be offered through minimally invasive access and is safe for the mother. Fetal Diagnosis and Therapy now publishes 2 additional clinical series with percutaneous fetoscopic endoluminal tracheal occlusion (FETO), suggesting an increased survival rate after fetal surgery [14][15][16][17] . Though the published experience seems to demonstrate variable degrees of benefit of fetal therapy, one should remember this remains an experimental procedure, in the sense that it is not a therapy with proven efficacy (as is the case for many other fetal therapies).…”

Antenatal management of isolated congenital diaphragmatic hernia today and tomorrow: ongoing collaborative research and development

“…A similar increase in survival after TO (although slight differences in protocols) has been observed in Brazil and Germany [36][37][38]. Obviously, this claim of improved outcome must now be proven in appropriately designed trials.…”

Predictors of neonatal morbidity in fetuses with severe isolated congenital diaphragmatic hernia undergoing fetoscopic tracheal occlusion

“…The FETO procedure has been described in detail 22,23,28 . Briefly it consists of the percutaneous fetoscopic insertion of a balloon into the fetal trachea, which in general is performed at approximately 26-28 (range, [23][24][25][26][27][28][29][30][31][32][33] weeks' gestation. The balloon is preferentially removed in utero at approximately 34 weeks by tracheoscopy or ultrasound-guided puncture.…”