In Utero Restoration of Hindbrain Herniation in Fetal Myelomeningocele as Part of Prenatal Regenerative Therapy Program at Mayo Clinic

Ruano, Rodrigo; Daniels, David J.; Ahn, Edward S.; Ibirogba, Eniola R.; Lu, Victor M.; Snyder, Kendall; Trinidad, Mari Charisse; Carey, William A.; Colby, Christopher E.; Kolbe, Amy B.; Arendt, Katherine W.; Segura, Leal G.; Sviggum, Hans P; Qureshi, Muhammad Yasir; Famuyide, Abimbola O.; Terzic, André

doi:10.1016/j.mayocp.2019.10.039

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…For symptomatic patients, it is recommended that fetal therapy be postponed until maternal conditions stabilize and patients have recovered from the disease. Some examples of fetal surgeries that are still currently offered at Mayo Clinic include fetoscopic laser ablation of placental anastomoses for twin-to-twin transfusion syndrome, 78 in utero repair of spina bifida, 79 intrauterine fetal blood transfusion, 80 in utero intervention for lower urinary tract obstruction, 81 fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia, 82 in utero procedure for fetal tumors associated with hydrops, 83 and in utero intervention for severe congenital heart defects. 84…”

Section: Fetal Therapymentioning

confidence: 99%

SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review

Narang

Enninga

Gunaratne

et al. 2020

Mayo Clinic Proceedings

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219

210

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The global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has been associated with worse outcomes in several patient populations, including the elderly and those with chronic comorbidities. Data from previous pandemics and seasonal influenza suggest that pregnant women may be at increased risk for infectionassociated morbidity and mortality. Physiologic changes in normal pregnancy and metabolic and vascular changes in high-risk pregnancies may affect the pathogenesis or exacerbate the clinical presentation of COVID-19. Specifically, SARS-CoV-2 enters the cell via the angiotensin-converting enzyme 2 (ACE2) receptor, which is upregulated in normal pregnancy. Upregulation of ACE2 mediates conversion of angiotensin II (vasoconstrictor) to angiotensin-(1-7) (vasodilator) and contributes to relatively low blood pressures, despite upregulation of other components of the reninangiotensin-aldosterone system. As a result of higher ACE2 expression, pregnant women may be at elevated risk for complications from SARS-CoV-2 infection. Upon binding to ACE2, SARS-CoV-2 causes its downregulation, thus lowering angiotensin-(1-7) levels, which can mimic/worsen the vasoconstriction, inflammation, and pro-coagulopathic effects that occur in preeclampsia. Indeed, early reports suggest that, among other adverse outcomes, preeclampsia may be more common in pregnant women with COVID-19. Medical therapy, during pregnancy and breastfeeding, relies on medications with proven safety, but safety data are often missing for medications in the early stages of clinical trials. We summarize guidelines for medical/obstetric care and outline future directions for optimization of treatment and preventive strategies for pregnant patients with COVID-19 with the understanding that relevant data are limited and rapidly changing.

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Section: Fetal Therapymentioning

confidence: 99%

SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review

Narang

Enninga

Gunaratne

et al. 2020

Mayo Clinic Proceedings

Self Cite

219

210

View full text Add to dashboard Cite

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“…As mentioned, myelomeningocele coexists in an overwhelming majority of patients with a Chiari II malformation ( Adzick et al, 2011 ). This clinical association is significant when considering treatment, as surgical correction of fetal myelomeningocele can decrease the severity of the Chiari II malformation in form of resolution of the hindbrain herniation and restoration of the CSF flow ( Ruano et al, 2020 ). The trial also provided evidence supporting favorable outcomes in the prenatal-surgical group.…”

Section: Discussionmentioning

confidence: 99%

Abnormal prenatal brain development in Chiari II malformation

et al. 2023

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IntroductionThe Chiari II is a relatively common birth defect that is associated with open spinal abnormalities and is characterized by caudal migration of the posterior fossa contents through the foramen magnum. The pathophysiology of Chiari II is not entirely known, and the neurobiological substrate beyond posterior fossa findings remains unexplored. We aimed to identify brain regions altered in Chiari II fetuses between 17 and 26 GW.MethodsWe used in vivo structural T2-weighted MRIs of 31 fetuses (6 controls and 25 cases with Chiari II).ResultsThe results of our study indicated altered development of diencephalon and proliferative zones (ventricular and subventricular zones) in fetuses with a Chiari II malformation compared to controls. Specifically, fetuses with Chiari II showed significantly smaller volumes of the diencephalon and significantly larger volumes of lateral ventricles and proliferative zones.DiscussionWe conclude that regional brain development should be taken into consideration when evaluating prenatal brain development in fetuses with Chiari II.

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“…Early MMC closure restores hindbrain herniation, which has been associated with a lower risk of hydrocephalus when compared with postnatal MMC closure 163. Small series have shown that in utero MMC closure improves hindbrain herniation prenatally, as early as 4-6 weeks postoperatively 168186…”

Section: Fetal Endoscopic Surgeriesmentioning

confidence: 99%

Prenatal regenerative fetoscopic interventions for congenital anomalies

Ruano

2020

BMJ

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Abstract Fetal intervention has progressed in the past two decades from experimental proof-of-concept to practice-adopted, life saving interventions in human fetuses with congenital anomalies. This progress is informed by advances in innovative research, prenatal diagnosis, and fetal surgical techniques. Invasive open hysterotomy, associated with notable maternal-fetal risks, is steadily replaced by less invasive fetoscopic alternatives. A better understanding of the natural history and pathophysiology of congenital diseases has advanced the prenatal regenerative paradigm. By altering the natural course of disease through regrowth or redevelopment of malformed fetal organs, prenatal regenerative medicine has transformed maternal-fetal care. This review discusses the uses of regenerative medicine in the prenatal diagnosis and management of three congenital diseases: congenital diaphragmatic hernia, lower urinary tract obstruction, and spina bifida.

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In Utero Restoration of Hindbrain Herniation in Fetal Myelomeningocele as Part of Prenatal Regenerative Therapy Program at Mayo Clinic

Cited by 7 publications

References 18 publications

SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review

SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review

Abnormal prenatal brain development in Chiari II malformation

Prenatal regenerative fetoscopic interventions for congenital anomalies

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