Fetal Pulmonary Response After Fetoscopic Tracheal Occlusion for Severe Isolated Congenital Diaphragmatic Hernia

Ruano, Rodrigo; Silva, Marcos Marques da; Campos, Juliana Álvares Duarte Bonini; Papanna, Ramesha; Moise, Kenneth J.; Tannuri, Uenis; Zugaib, Marcelo

doi:10.1097/aog.0b013e31823d3aea

Cited by 46 publications

(40 citation statements)

References 39 publications

(30 reference statements)

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“…Cannie et al [13] showed a significant association between lung response at about 3 weeks from FETO, measured as the increase in total lung volume by MRI, and postnatal survival. Similarly, Ruano et al [14] reported that the total lung volume measured by three-dimensional ultrasound and the contralateral pulmonary vascularization index at 4 weeks from FETO were independently associated with survival. Future large studies combining fetal ultrasound and MRI measurements could be useful to provide accurate preoperative prediction of lung response to tracheal occlusion, and therefore to define the subgroup of fetuses with CDH that would benefit most from FETO.…”

Section: Discussionmentioning

confidence: 99%

Fetoscopic Endoluminal Tracheal Occlusion in Fetuses with Severe Diaphragmatic Hernia: A Three-Year Single-Center Experience

et al. 2016

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Objective: To report on our experience in the prenatal treatment of severe congenital diaphragmatic hernia (CDH) by fetoscopic endoluminal tracheal occlusion (FETO). Methods: Between 2012 and 2014, FETO was performed at our center in 21 cases of CDH considered to be severe based on sonographic measurement of observed/expected lung-to-head ratio (O/E LHR) and side of the defect. We reported pre- and postoperative ultrasound findings, procedure-related complications, pregnancy outcome and survival at 1-3 years of age. Results: The median gestational age (GA) at balloon insertion was 28.1 weeks (range 26.0-31.1) and the median GA at delivery 34.7 weeks (range 31.6-39.0); delivery before 32 and 34 weeks occurred in 2 (9.5%) and 7 (33.3%) cases, respectively. Postnatal survival at 1-3 years of age in the 17 cases with isolated unilateral CDH was 47.1%. The percentage difference between pre-balloon removal O/E LHR and pre-FETO O/E LHR was significantly higher in survivors compared to neonates who died (40.8 vs. 21.2%, respectively; p < 0.05). Conclusions: In this study, FETO was associated with an infant survival of 47% in cases with isolated unilateral severe CDH. The post-FETO increase in O/E LHR was higher in fetuses that survived compared to those who died.

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Section: Discussionmentioning

confidence: 99%

Fetoscopic Endoluminal Tracheal Occlusion in Fetuses with Severe Diaphragmatic Hernia: A Three-Year Single-Center Experience

et al. 2016

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“…Severe forms of isolated CDH are associated with high neonatal mortality and morbidity due to extremely reduced lung volumes, liver herniation and decreased pulmonary vascularization. Fetal endoscopic tracheal occlusion performed between 26 and 30 weeks (standard FETO) has been shown to increase fetal pulmonary size and vascularity, and to improve neonatal survival in isolated cases of severe CDH. Fetal pulmonary response following FETO can be used to predict outcome and is dependent on size of the fetal lung prior to the procedure.…”

Section: Introductionmentioning

confidence: 99%

Early fetoscopic tracheal occlusion for extremely severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: preliminary results

Ruano

Peiró

Silva

et al. 2013

Ultrasound in Obstet & Gyne

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“…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 …”

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confidence: 99%

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

Novoa

Sutton

Neis

et al. 2018

J of Ultrasound Medicine

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Objectives The aim of this study was to investigate the reproducibility of a standardized method to assess the ultrasound liver‐to‐thoracic area ratio in fetuses with congenital diaphragmatic hernia. Methods We selected 24 images of 9 fetuses diagnosed with left‐sided at our institution between January 2010 and December 2017. Eight operators (1 maternal‐fetal medicine specialist and 7 sonographers) reviewed the selected images and assessed the ultrasound liver‐to‐thoracic area ratio according to a standardized protocol. We evaluated the correlation between operators using the intraclass correlation coefficient and compared agreement between the sonographers and a physician with experience in measuring the ultrasound liver‐to‐thoracic area ratio using a Bland‐Altman analysis. Results Good intraoperator reproducibility was observed for the standardized ultrasound liver‐to‐thoracic area ratio (intraclass correlation coefficient, 0.78). Good agreement among sonographers and the physician was also observed for the standardized measurements (bias, 0.01; precision, 0.03; limits of agreement, –0.05 to + 0.07). Conclusions We demonstrated that good intraoperator and interoperator reproducibility of ultrasound liver‐to‐thoracic area ratio assessment is feasible after standardizing the method in our center.

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Fetal Pulmonary Response After Fetoscopic Tracheal Occlusion for Severe Isolated Congenital Diaphragmatic Hernia

Abstract: Fetal endoscopic tracheal occlusion improves survival rate by increasing the lung size and pulmonary vascularity in fetuses with severe congenital diaphragmatic hernia. The pulmonary response after fetal endoscopic tracheal occlusion can be used to predict neonatal survival.

Cited by 46 publications

References 39 publications

Fetoscopic Endoluminal Tracheal Occlusion in Fetuses with Severe Diaphragmatic Hernia: A Three-Year Single-Center Experience

Fetoscopic Endoluminal Tracheal Occlusion in Fetuses with Severe Diaphragmatic Hernia: A Three-Year Single-Center Experience

Early fetoscopic tracheal occlusion for extremely severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: preliminary results

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

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