The impact of fetal endoscopic tracheal occlusion in isolated left‐sided congenital diaphragmatic hernia on left‐sided cardiac dimensions

Dhillon, Gurpreet S.; Maskatia, Shiraz A.; Loar, Robert W.; Colquitt, John L.; Mehollin-Ray, Amy R.; Ruano, Rodrigo; Belfort, Michael A.; Olutoye, Oluyinka O.; Kailin, Joshua A.

doi:10.1002/pd.5333

Cited by 7 publications

(9 citation statements)

References 55 publications

(154 reference statements)

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“…Early FETO Belfort (2017) 28 Deprest (2021) 12 Dhillon (2018) 29 Style (2019) 32 Subtotal (95% CI) Total events…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

“…Twenty-five articles published between 2003 and 2022 were included in the qualitative synthesis , and data from 20 articles were included in the quantitative synthesis (Figure 1) [12][13][14][17][18][19][21][22][23][24][25][27][28][29][30][32][33][34][35][36] . Among them, the four RCTs [12][13][14]21 were rated as having a low risk of bias using the RoB-2 tool, while, among the 16 cohort studies [17][18][19][22][23][24][25][27][28][29][30][32][33][34][35][36] , three were rated as having a low risk, 11 were rated as having a moderate risk and two were rated as having a serious risk of bias using the ROBINS-I tool (Table 1, Figure 2). A total of 1187 CDH patients were included in the meta-analysis, among whom 639 underwent FETO.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

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Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta‐analysis

Chen

Xie

et al. 2023

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?There is an ongoing debate regarding whether the impact of fetal endoscopic tracheal occlusion (FETO) varies in severe and moderate congenital diaphragmatic hernia (CDH). We demonstrate that FETO is associated with a reduction in mortality, rate of pulmonary hypertension and use of extracorporeal membrane oxygenation (ECMO) in severe CDH, but reduces only mortality in moderate CDH. In addition, FETO is associated with late preterm birth (but not extreme prematurity) regardless of CDH severity or timing of FETO. What are the clinical implications of this work?FETO should be recommended primarily for severe CDH to reduce mortality, risk of pulmonary hypertension and ECMO usage. Patients should be informed regarding the increased risk of late prematurity but not of extreme prematurity. Further evaluation is warranted to clarify the risk/benefit ratio of FETO in moderate CDH.

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“…Early FETO Belfort (2017) 28 Deprest (2021) 12 Dhillon (2018) 29 Style (2019) 32 Subtotal (95% CI) Total events…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta‐analysis

Chen

Xie

et al. 2023

Ultrasound in Obstet & Gyne

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“…The specific effect of FETO on the fetal heart has been investigated in observational cohort studies. Insertion and removal of the tracheal balloon is not associated with measurable changes in LV dimensions or function in the fetal period [51][52][53] . However, Alves de Rocha et al have observed increased LV and aortic dimensions postnatally in those infants who received fetal tracheal occlusion 54 .…”

Section: Effect Of Fetal Therapies On the Heart In Cdhmentioning

confidence: 94%

“Heart of the Matter”: Cardiac Dysfunction in Congenital Diaphragmatic Hernia

Gowda

Patel

2023

Am J Perinatol

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Despite advances in caring for neonates with congenital diaphragmatic hernia (CDH), mortality and morbidity continues to be high. Additionally, the pathophysiology of cardiac dysfunction in this condition is poorly understood. Postnatal cardiac dysfunction in neonates with CDH may be multifactorial with origins in fetal life. Mechanical obstruction, competition from herniated abdominal organs into thoracic cavity combined with redirection of ductus venosus flow away from patent foramen ovale leading to smaller left-sided structures may be a contributing factor. This shunting decreases left atrial and left ventricular blood volume which may result in altered micro- and macro- vascular aberrations affecting cardiac development in the prenatal period. Direct mass effect from herniated intra-abdominal contents restricting cardiac growth, and/or reduced left ventricular preload may contribute independently to left ventricular dysfunction in the absence of right ventricular dysfunction and or pulmonary hypertension. With variable clinical phenotypes of cardiac dysfunction, pulmonary hypertension, and respiratory failure in patients with CDH, there is increased need for individualized diagnosis and tailored therapy. Routine use of therapy such as inhaled nitric oxide (iNO) and sildenafil which induces significant pulmonary vasodilation may be detrimental in LV dysfunction whereas in a patient with pure RV dysfunction, they may be beneficial. Targeted functional echocardiography serves as a real time tool for defining the pathophysiology and aids optimization of vasoactive therapy in affected neonates.

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“…The gestational age at insertion is also related to the degree of tracheomegaly, and early insertions may cause more clinical problems (62,63). The most commonly reported neonatal outcomes are survival and gestational age (GA) at delivery with comparative studies consistently reporting earlier GA at delivery for FETO and mixed results around survival (see Table 1) (37,40,42,47,57,(64)(65)(66)(67)(68)(69)(70)(71). A few studies report rates of extracorporeal membrane oxygenation (ECMO) utilization and severe pulmonary hypertension and that neonates who received FETO have lower rates of both (47,65,67,68,71).…”

Section: A B Cmentioning

confidence: 99%

Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: a narrative review of the history, current practice, and future directions

Perrone¹,

Deprest²

2021

Transl Pediatr

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Fetal intervention for fetuses with congenital diaphragmatic hernia (CDH) has been investigated for over 30 years and is summarized in this manuscript. The review begins with a discussion of the history of fetal intervention for this severe congenital anomaly beginning with open fetal surgery with repair of the anatomical defect, shifting towards tracheal occlusion via open surgery techniques, and finally fetoscopic endoluminal balloon tracheal occlusion using a percutaneous approach. The current technique of fetal endoscopic tracheal occlusion (FETO) is described in detail with steps of the procedure and complementary figures. The main outcomes of single-institutional studies and multiple systematic reviews are examined and discussed. Despite these studies, the fetal community agrees that FETO remains investigational at this time as there is insufficient evidence to recommend it as the standard of care for CDH. A randomized controlled trial, The Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trial, has been designedto attempt to answer this question in an elaborate, international, multi-institutional study and is described in the text. Finally, future directions of fetal intervention for antenatally diagnosed CDH are discussed, including options for non-isolated CDH, the Smart-TO balloon for nonoperative reversal of occlusion, and transplacental sildenafil for treatment of pulmonary hypertension prior to birth.

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The impact of fetal endoscopic tracheal occlusion in isolated left‐sided congenital diaphragmatic hernia on left‐sided cardiac dimensions

Abstract: Although increased lung growth was seen after FETO, fetal LHH persisted with relative normalization seen post-repair. Persistent LHH post-FETO could be secondary to a small contribution of pulmonary venous return to the fetal left heart and increased intrathoracic pressures post-FETO.

Cited by 7 publications

References 55 publications

Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta‐analysis

Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta‐analysis

“Heart of the Matter”: Cardiac Dysfunction in Congenital Diaphragmatic Hernia

Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: a narrative review of the history, current practice, and future directions

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