Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion

Abstract

K E Y W O R D S:congenital diaphragmatic hernia; fetal therapy; fetal tracheal occlusion; lung-to-head ratio; pulmonary hypoplasia ABSTRACT Objectives To examine operative and perinatal aspects of fetal endoscopic tracheal occlusion (FETO) in congenital diaphragmatic hernia (CDH). Methods

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

“…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.…”

“…In-utero reversal at approximately 34 weeks' gestation has been suggested to enhance pulmonary maturation 27 , to allow vaginal delivery and to allow the patient to return to the initial referral center. The FETO consortium recently reported on the outcome of 210 consecutive procedures 28 . In comparison to outcomes reported by the antenatal CDH registry, FETO would increase survival rate in severe cases with left-sided CDH from 24 to 49%, and in right-sided cases from 0 to 35% (P < 0.001).…”

“…In comparison to outcomes reported by the antenatal CDH registry, FETO would increase survival rate in severe cases with left-sided CDH from 24 to 49%, and in right-sided cases from 0 to 35% (P < 0.001). The strongest predictors of survival are O/E-LHR before the procedure, the occurrence of premature rupture of membranes (PROM) and gestational age at delivery 17,18,28 . Here we report on early neonatal morbidity in survivors, and also correlate outcome with variables available in the prenatal period.…”

A review of congenital diaphragmatic hernia

“…Right‐sided CDH has a poorer outcome 4 , 14 , 27 primarily due to the liver herniation into the chest. Liver herniation is an independent predictor of mortality in CDH 15 …”

“…MRI has recently been established as an adjunct to ultrasound in not only the diagnosis of CDH but also to aid the estimation of lung volume 27 29 MRI can provide clarity in cases where ultrasound imaging has been sub optimal and can increase detection of liver herniation 27 …”