Fetoscopic Therapy for Severe Pulmonary Hypoplasia in Congenital Diaphragmatic Hernia: A First in Prenatal Regenerative Medicine at Mayo Clinic

Ruano, Rodrigo; Klinkner, Denise B.; Balakrishnan, Karthik; Novoa, Victoria Arruga Novoa y; Davies, Norman; Potter, Dean D.; Carey, William A.; Colby, Christopher E.; Kolbe, Amy B.; Arendt, Katherine W.; Segura, Leal G.; Sviggum, Hans P; Lemens, Maureen A.; Famuyide, Abimbola O.; Terzic, André

doi:10.1016/j.mayocp.2018.02.026

Cited by 20 publications

(43 citation statements)

References 21 publications

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“…The FETO procedure is performed by a multispecialty team under local mother and fetus anesthesia using a tiny telescope (2–3 mm fetoscopes) . Briefly, a fetoscope is inserted percutaneously to the uterus, guided through ultrasound.…”

Section: Early Lung Regeneration Achieved With Fetal Surgerymentioning

confidence: 99%

“…The scope is then inserted through the mouth of the fetus until it reaches the trachea, where a detachable balloon is placed just above the karina ( Figure ). Removal of the balloon before birth can be done through different procedures, including in utero percutaneous fetoscopy, percutaneous ultrasound‐guided needle puncture, or ex utero intrapartum treatment delivery procedure, determined by the surgical/interventional team and the clinical conditions of the patient and mother …”

Section: Early Lung Regeneration Achieved With Fetal Surgerymentioning

confidence: 99%

“…The clinical experience with FETO is promising, with clinical trials documenting improvement in perinatal organ form and function as well as in postnatal survival rate . Indeed, the measured regenerative outcome demonstrates FETO‐induced growth of hypoplastic lungs in utero .…”

Section: Early Lung Regeneration Achieved With Fetal Surgerymentioning

confidence: 99%

“…Rodrigo Ruano 1,2,3 , Elizabeth Ann L. Enninga 1 , Paola E. Brana Rivera 1 and Andre Terzic 3 Technology advances have raised the outlook for regenera tive solutions aimed at restoring organ health. Fetal surgery, implemented to reinstate early organ growth and restitute function in select congenital conditions, is increasingly considered with the prospect of improved postnatal outcomes.…”

Section: Regenerative Prophylaxis In Uteromentioning

confidence: 99%

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Regenerative Prophylaxis In Utero

Ruano

Enninga

Rivera

et al. 2018

Clin Pharma and Therapeutics

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Technology advances have raised the outlook for regenerative solutions aimed at restoring organ health. Fetal surgery, implemented to reinstate early organ growth and restitute function in select congenital conditions, is increasingly considered with the prospect of improved postnatal outcomes. Here, we highlight clinical prenatal interventions for rescue of fetal lung development in congenital diaphragmatic hernia, and fetal neurological regeneration for spina bifida. Regenerative therapeutic care in utero is poised to transform management algorithms.

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Section: Early Lung Regeneration Achieved With Fetal Surgerymentioning

confidence: 99%

Section: Early Lung Regeneration Achieved With Fetal Surgerymentioning

confidence: 99%

Section: Early Lung Regeneration Achieved With Fetal Surgerymentioning

confidence: 99%

Section: Regenerative Prophylaxis In Uteromentioning

confidence: 99%

See 2 more Smart Citations

Regenerative Prophylaxis In Utero

Ruano

Enninga

Rivera

et al. 2018

Clin Pharma and Therapeutics

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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 …”

mentioning

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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Sonographic pulmonary response after tracheal occlusion in fetuses with severe isolated congenital diaphragmatic hernia

Trad

Czeresnia

Ibirogba

et al. 2022

J of Clinical Ultrasound

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Purpose To report the longitudinal lung growth and prognosis of fetuses with severe left sided congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO) in a single institution. Methods Fetal lung size (observed‐to‐expected lung area to head circumference [o/e‐LHR]) was measured in seven consecutive fetuses with isolated severe left‐sided CDH who underwent FETO. Fetal lung growth was used to prognosticate survival and need for ECMO. Results Seven consecutive fetuses had a FETO procedure in the timeframe of this study. A total of 44 longitudinal ultrasound were performed to evaluate lung development. FETO was performed at GA 28.5 ± 0.5 weeks. Five (71.4%) infants survived to one‐year follow‐up and ECMO was needed in three patients (42.8%). Fetal lung response was observed in all fetuses; mean o/e‐LHR increased from 22.5% ± 1.4 before FETO to 44.4% ± 9.8 before delivery. Infants who survived had a higher percentage of fetal lung growth (21.8%) than those who died (8.25%). Conclusion Our study supports the hypothesis that FETO promotes fetal lung growth in fetuses with severe left‐sided CDH, and the fetal pulmonary response seems to be associated with improved outcomes after the procedure.

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Fetoscopic Therapy for Severe Pulmonary Hypoplasia in Congenital Diaphragmatic Hernia: A First in Prenatal Regenerative Medicine at Mayo Clinic

Cited by 20 publications

References 21 publications

Regenerative Prophylaxis In Utero

Regenerative Prophylaxis In Utero

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

Sonographic pulmonary response after tracheal occlusion in fetuses with severe isolated congenital diaphragmatic hernia

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