Fetoscopic Tracheal Occlusion (FETO) for Severe Congenital Diaphragmatic Hernia: Evolution of a Technique and Preliminary Results

Deprest, Jan; Gratacós, Eduard; Nicolaides, K. H.

doi:10.1097/01.ogx.0000151637.60296.a0

Cited by 119 publications

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“…Severe hypoplasia was defined as sonographic evidence of intrathoracic herniation of the liver and an O/E-LHR of < 25% in left-sided defects or < 45% in right-sided CDH. 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.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

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

Doné

Gratacós

Nicolaides

et al. 2013

Ultrasound in Obstet & Gyne

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Section: Methodsmentioning

confidence: 99%

“…Fetal endoscopic tracheal occlusion (FETO) involves the percutaneous placement of an inflatable balloon in the fetal trachea under sonoendoscopic guidance 22 -25 . The balloon prevents egress of lung fluid, causing airway stretch, which in turn results in lung growth 26 .…”

Section: Introductionmentioning

confidence: 99%

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

Doné

Gratacós

Nicolaides

et al. 2013

Ultrasound in Obstet & Gyne

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“…In utero removal can be done either by fetoscopy or ultrasound-guided puncture; however the center must be ready at all times to offer emergency peripartum removal by laryngo-tracheoscopy if required. Initially procedures were done under general anesthesia, but we quickly moved to local regional or even local anesthesia with fetal sedation and immobilization (Deprest et al, 2004).…”

Section: Clinical Interventionmentioning

confidence: 99%

Prenatal diagnosis, prediction of outcome and in utero therapy of isolated congenital diaphragmatic hernia

et al. 2008

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Congenital diaphragmatic hernia (CDH) can be associated with genetic or structural anomalies with poor prognosis. In isolated cases, survival is dependent on the degree of lung hypoplasia and liver position. Cases should be referred in utero to tertiary care centers familiar with this condition both for prediction of outcome as well as timed delivery. The best validated prognostic indicator is the lung area to head circumference ratio. Ultrasound is used to measure the lung area of the index case, which is then expressed as a proportion of what is expected normally (observed/expected LHR). When O/E LHR is <25% survival chances are <15%. Prenatal intervention, aiming to stimulate lung growth, can be achieved by temporary fetal endoscopic tracheal occlusion (FETO). A balloon is percutaneously inserted into the trachea at 26-28 weeks, and reversal of occlusion is planned at 34 weeks. Growing experience has demonstrated the feasibility and safety of the technique with a survival rate of about 50%. The lung response to, and outcome after FETO, is dependent on pre-existing lung size as well gestational age at birth. Early data show that FETO does not increase morbidity in survivors, when compared to historical controls. Several trials are currently under design.

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“…Hérnia diafragmática congênita (HDC) é um defeito esporádico com prevalência ao nascimento de cerca de 1 em 4000 38 . Ocorre quando o diafragma não se forma corretamente, permitindo que vísceras abdominais adentrem o tórax através do defeito, levando à ocorrência de hipoplasia e hipertensão pulmonares, que são as principais causas de morbidade e mortalidade neonatal nesse grupo de pacientes 39 .…”

Section: Iii) Oclusão Endotraqueal Fetal Na Hérnia Diafragmática Congunclassified

“…Deprest et al 38 , em 2004, publicaram resultados positivos da oclusão endotraqueal em fetos humanos. Vinte e um fetos foram submetidos ao procedimento realizado entre 25-29 semanas em fetos com LHR <1 e utilizando a via de acesso endoscópica para oclusão da traquéia fetal com um pequeno balão vascular de 7 mm de diâmetro sob visualização direta.…”

Section: Iii) Oclusão Endotraqueal Fetal Na Hérnia Diafragmática Congunclassified

Cirurgia fetal no contexto atual

Rocha

Filho

Bunduki

et al. 2018

Rev. Med. (São Paulo)

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RESUMO:A cirurgia fetal é, hoje, uma realidade em grandes centros especializados na área da medicina fetal. Surgiu por volta da década de 1960, inicialmente atrelada à necessidade de melhor conhecer e entender as patologias fetais, e teve desenvolvimento exponencial impulsionado pelo aprimoramento das técnicas diagnósticas pré-natais. Foi aos poucos se consolidando e tornando-se o tratamento de escolha para algumas patologias específicas, mudando definitivamente o curso dessas doenças. Nesse estudo, encontra-se um breve histórico das cirurgias fetais mais comumente realizadas em todo o mundo, como elas surgiram e como foram evoluindo com o passar do tempo, os principais estudos que as validaram e a técnica cirúrgica mais amplamente utilizada em cada caso. Entre as principais cirurgias, são citadas a fotocoagulação a laser de anastomoses placentárias na síndrome de transfusão feto-fetal, a correção intrauterina a céu aberto da mielomeningocele fetal e a oclusão endotraqueal fetal por balão nos casos de hérnia diafragmática congênita. Também são abordados cirurgias e procedimentos cujos benefícios são menos evidentes e os resultados ainda um tanto controversos, como as intervenções urinárias nos casos de obstrução ao trato urinário inferior, procedimentos cardíacos em casos de estenose aórtica crítica, derivações tóracoamnióticas para tratamento de derrames pleurais compressivos, além de ressecções intrauterinas de teratomas sacrococcígeos e de massas pulmonares. Também é feita uma avaliação a respeito do futuro da cirurgia fetal.Descritores: Feto/cirurgia; Fetoscopia. ABSTRACT:Fetal surgery is now a reality in large centers that specialize in the field of fetal medicine. Fetal surgery emerged in the 1960s, primarily from the need to better identify and understand fetal pathologies, and its exponential development was driven by improvements in prenatal diagnostic techniques. Fetal surgery gradually became the main treatment for specific fetal pathologies, changing the course of these diseases. This study summarizes the history of the fetal surgeries that are most commonly performed worldwide, how they started and how they evolved over time, the main validation trials and the most widely used surgical technique in each case. The main surgeries include laser photocoagulation of placental anastomoses in twin-to-twin transfusion syndrome, in utero repair of fetal myelomeningocele and fetal endotracheal occlusion in cases of congenital diaphragmatic hernia. Other surgeries and procedures, whose benefits are less clear and whose results are still somewhat controversial, such as urinary interventions in cases of lower urinary tract obstruction, cardiac procedures in cases of critical aortic stenosis, thoracoamniotic shunts for the treatment of massive pleural effusions and intrauterine resection of sacrococcygeal teratomas and pulmonary masses, are also cited. The future of fetal surgery is also assessed.

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Fetoscopic Tracheal Occlusion (FETO) for Severe Congenital Diaphragmatic Hernia: Evolution of a Technique and Preliminary Results

Cited by 119 publications

References 0 publications

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

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

Prenatal diagnosis, prediction of outcome and in utero therapy of isolated congenital diaphragmatic hernia

Cirurgia fetal no contexto atual

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