Fetoscopic temporary tracheal occlusion for congenital diaphragmatic hernia: prelude to a randomized, controlled trial

Harrison, Michael R.; Sydorak, Roman M.; Farrell, Jody A.; Kitterman, Joseph A.; Filly, Roy A.; Albanese, Craig T.

doi:10.1016/s0022-3468(03)00182-9

Cited by 112 publications

(59 citation statements)

References 31 publications

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“…To cut the clinical 'plug' odyssey short, tracheal occlusion was initially performed by laparotomy, hysterotomy, fetal neck dissection and tracheal clipping (Flake et al, 2000) but later moved to multiple uterine cannulation to allow fetoscopic tracheal dissection and clipping (Harrison et al, 2003b). The use of an endotracheal balloon, as we first described in sheep, made it possible to occlude the trachea through a single 3.3 mm port (Flageole et al, 1997;Deprest et al, 1998) (Figure 5).…”

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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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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“…O procedimento foi denominado, Fetendo-Clip 35 , intervenção bem menos invasiva, que foi rapidamente empregada na pratica clínica 36 . Embora tenha tido avanço na via de acesso, essa técnica também foi abandonada devido às altas taxas de prematuridade e de lesões irreversíveis que ocorriam na traqueia e no nervo laríngeo recorrente dos fetos 37 . Benachi et al 38 descreveram uma técnica menos invasiva de TO, em fetos de ovelhas, usando um balão destacável também por via fetoscópica videoassistida.…”

Section: História Da Intervenção Fetal E O Diagnóstico Pré-natalunclassified

Manejo pré-natal da hérnia diafragmática congênita: presente, passado e futuro

Gallindo

Gonçalves

Figueira

et al. 2015

Rev. Bras. Ginecol. Obstet.

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Manejo pré-natal da hérnia diafragmática congênita: presente, passado e futuro ResumoA hérnia diafragmática congênita é um defeito de formação do diafragma que acomete entre 1:2.000 e 1:4.000 nascidos vivos e constitui 8% das principais anomalias congênitas. Avanços médicos nos últimos 30 anos envolvendo diagnóstico pré-natal, intervenção fetal, manejo clinico e cirúrgico neonatal têm mudado a sobrevivência dos seus portadores. A evolução histórica desses avanços ajuda a compreender o esforço na busca de melhores resultados desse defeito muitas vezes fatal. Perspectivas na utilização de bioengenharia e terapia envolvendo células tronco podem trazer novas esperanças para os fetos com hérnia diafragmática congênita. AbstractThe congenital diaphragmatic hernia is a defect in the formation of the diaphragm, which affects between 1:2,000 and 1:4,000 live births and represents 8% of major congenital anomalies. Medical advances in the last 30 years involving prenatal diagnosis, fetal intervention, neonatal surgical and clinical management have changed the survival of these patients. The historical evolution of these advances helps us to understand the effort in pursuit of better results of this defect, which is often lethal. Perspectives on the use of bioengineering and therapy involving stem cells may bring new hope for fetuses with congenital diaphragmatic hernia.

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“…This is currently clinically achieved by minimally invasive fetal endoscopic tracheal occlusion (FETO) which results in an apparent increase in survival [29,30]. Beneficial pulmonary effects may be offset by the increased likelihood for preterm delivery, mainly by preterm rupture of the fetal membranes [31,32,33]. Other predictors of outcome following FETO are lung size prior to balloon insertion and the ability to remove the balloon prior to birth [34].…”

Section: Introductionmentioning

confidence: 99%

Prediction of Neonatal Respiratory Function and Pulmonary Hypertension in Fetuses with Isolated Congenital Diaphragmatic Hernia in the Fetal Endoscopic Tracleal Occlusion Era: A Single-Center Study

Doné¹,

Debeer

Gucciardo³

et al. 2014

Fetal Diagn Ther

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Objective: To correlate prenatal indicators of pulmonary hypoplasia with neonatal lung function and pulmonary hypertension (PHT) in isolated congenital diaphragmatic hernia (iCDH). Materials and Methods: Prospective single-center study on 40 fetuses with iCDH either expectantly managed (n = 13) or undergoing tracheal occlusion (n = 27). Prenatal predictors included observed/expected lung-head ratio (O/E LHR), observed/expected total fetal lung volume, fetal pulmonary reactivity to maternal O₂ administration (Δpulsatility index, ΔPI) and liver-to-thorax ratio (LiTR) as measured in the second and third trimesters. Postnatal outcome measures included survival until discharge, best oxygenation index (OI) and alveolar-arterial oxygen gradient [D(A-a)O₂] in the first 24 h of life and the occurrence of PHT in the first 28 days of life. Results: Median gestational age (GA) at evaluations was 27.2 and 34.3 weeks. GA at delivery was 36.0 weeks, and overall survival was 55%. In the second trimester, measurement of lung size, LiTR and pulmonary reactivity were significantly related to survival and the best OI and D(A-a)O₂.The occurrence of PHT was better predicted by ΔPI and LiTR. Conclusions: O/E LHR, LiTR and vascular reactivity correlate with ventilatory parameters in the first 24 h of life. Occurrence of PHT at ≥28 days was best predicted by LiTR and ΔPI, but not by lung size.

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Fetoscopic temporary tracheal occlusion for congenital diaphragmatic hernia: prelude to a randomized, controlled trial

Cited by 112 publications

References 31 publications

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

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

Manejo pré-natal da hérnia diafragmática congênita: presente, passado e futuro

Prediction of Neonatal Respiratory Function and Pulmonary Hypertension in Fetuses with Isolated Congenital Diaphragmatic Hernia in the Fetal Endoscopic Tracleal Occlusion Era: A Single-Center Study

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