Feasibility and Outcomes of Fetoscopic Tracheal Occlusion for Severe Left Diaphragmatic Hernia

Abstract

ClinicalTrials.gov, https://clinicaltrials.gov, NCT00881660.

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

“…Texas Children's Fetal Center is one of the few centers in the United States studying the effect of tracheal occlusion to accelerate lung growth and is therefore a referral center for fetal intervention for CDH. Criteria for FETO at the time of this study, at our center, included lung‐to‐head ratio (LHR) <1, liver herniation into the fetal chest, 22 to 29‐week and 6‐day gestational age, singleton pregnancy, no major congenital heart disease (CHD), normal karyotype, absence of maternal contraindication to fetal surgery or anesthesia, and no latex allergy …”

“…Balloon retrieval was undertaken at approximately 34‐week gestation (between 32 and 35 weeks for our study population) and performed either fetoscopically using grasping forceps, punctured under ultrasound‐guidance, or removed by direct bronchoscopy during an ex utero intrapartum treatment procedure in the event of imminent delivery. The FETO procedure at our institution is described in further detail by Belfort et al…”

“…All patients in both control and intervention groups were potential ECMO candidates postnatally based on size and gestational age, and survived to postnatal CDH repair. All CDH neonates were managed in the Texas Children's Hospital NICU by providers who adhered to an established standardized diaphragmatic hernia treatment algorithm which includes strict ECMO utilization criteria …”

“…Fetal endoscopic tracheal occlusion is theorized to improve lung growth by preventing egress of pulmonary fluid and causing tissue stretch, which acts as a signal for accelerated lung growth and induces vascular changes . Outcomes, efficacy, and safety of FETO undergo ongoing evaluation in the age of the TOTAL trial …”

Reproducibility of Liver‐to‐Thorax Area Ratio Ultrasound Measurements in Congenital Diaphragmatic Hernia

“…Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm in which the abdominal viscera herniates into the chest, compromising lung growth. Congenital diaphragmatic hernia affects approximately 1 in 3000 live births and is associated with high rates of mortality, especially in cases with pulmonary hypoplasia and pulmonary arterial hypertension . Fetoscopic tracheal occlusion has been suggested for severe forms of CDH …”