Successful Repair in Utero of a Fetal Diaphragmatic Hernia after Removal of Herniated Viscera from the Left Thorax

Mr, Harrison; Ns, Adzick; Mt, Longaker; Jd, Goldberg; Ma, Ru; Ra, Filly; Mi, Evans; Ms, Golbus

doi:10.1056/nejm199005313222207

Cited by 273 publications

(56 citation statements)

References 16 publications

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“…In the literature only very few publications have shown an increased survival after prenatal treatment of congenital malformations [14]. Further, it seems very difficult to prove increased survival after prenatal diagnosis for livebirths with congenital malformations despite referral to a tertiary centre for treatment before birth [15].…”

Section: Discussionmentioning

confidence: 99%

Different Policies on Prenatal Ultrasound Screening Programmes and Induced Abortions Explain Regional Variations in Infant Mortality with Congenital Malformations

Garne

Berghold²,

Johnson³

et al. 2001

Fetal Diagn Ther

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Objective: To compare the impact of induced abortions (IA) on the mortality of infants with congenital malformations in four European regions with different policies on IA and prenatal ultrasound screening for congenital malformations. Methods: A registry-based collection of data on congenital malformations in four different countries: Ireland (Dublin), Denmark (Funen County), Austria (Styria), and France (Strasbourg). Results: The proportion of infant deaths with malformations ranged from 23 to 44% of all infant deaths with the highest proportion in Dublin, where IA is not allowed and prenatal ultrasound screening not performed. There were highly significant differences in the prevalences of IA (p < 0.001), fetal deaths (p < 0.01), and deaths in infants with congenital malformations (p < 0.001) between the four regions. The differences in total mortality with congenital malformations (IA + fetal deaths + infant deaths) between regions decreased, and only Strasbourg differs significantly from the other three regions. Conclusion: Prenatal ultrasound screening programmes have only a minor impact on total mortality with congenital malformations from 2nd trimester of pregnancy to 1 year of age, but seem to change the time of death which may be important for both the parents and the community.

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Section: Discussionmentioning

confidence: 99%

Different Policies on Prenatal Ultrasound Screening Programmes and Induced Abortions Explain Regional Variations in Infant Mortality with Congenital Malformations

Garne

Berghold²,

Johnson³

et al. 2001

Fetal Diagn Ther

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“…Nos anos 1980, após extensivos experimentos em ovelhas, Harrison e colegas descreveram pela primeira vez uma cirurgia aberta para correção de HDC, em que era feita histerotomia e correção do defeito diafragmático 41 . Apesar do relato de sucesso em alguns casos, estas cirurgias iniciais foram pouco encorajadoras devido à grande morbidade materna e fetal.…”

Section: Iii) Oclusão Endotraqueal Fetal Na Hérnia Diafragmática Congunclassified

Cirurgia fetal no contexto atual

Rocha

Filho

Bunduki

et al. 2018

Rev. Med. (São Paulo)

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RESUMO:A cirurgia fetal é, hoje, uma realidade em grandes centros especializados na área da medicina fetal. Surgiu por volta da década de 1960, inicialmente atrelada à necessidade de melhor conhecer e entender as patologias fetais, e teve desenvolvimento exponencial impulsionado pelo aprimoramento das técnicas diagnósticas pré-natais. Foi aos poucos se consolidando e tornando-se o tratamento de escolha para algumas patologias específicas, mudando definitivamente o curso dessas doenças. Nesse estudo, encontra-se um breve histórico das cirurgias fetais mais comumente realizadas em todo o mundo, como elas surgiram e como foram evoluindo com o passar do tempo, os principais estudos que as validaram e a técnica cirúrgica mais amplamente utilizada em cada caso. Entre as principais cirurgias, são citadas a fotocoagulação a laser de anastomoses placentárias na síndrome de transfusão feto-fetal, a correção intrauterina a céu aberto da mielomeningocele fetal e a oclusão endotraqueal fetal por balão nos casos de hérnia diafragmática congênita. Também são abordados cirurgias e procedimentos cujos benefícios são menos evidentes e os resultados ainda um tanto controversos, como as intervenções urinárias nos casos de obstrução ao trato urinário inferior, procedimentos cardíacos em casos de estenose aórtica crítica, derivações tóracoamnióticas para tratamento de derrames pleurais compressivos, além de ressecções intrauterinas de teratomas sacrococcígeos e de massas pulmonares. Também é feita uma avaliação a respeito do futuro da cirurgia fetal.Descritores: Feto/cirurgia; Fetoscopia. ABSTRACT:Fetal surgery is now a reality in large centers that specialize in the field of fetal medicine. Fetal surgery emerged in the 1960s, primarily from the need to better identify and understand fetal pathologies, and its exponential development was driven by improvements in prenatal diagnostic techniques. Fetal surgery gradually became the main treatment for specific fetal pathologies, changing the course of these diseases. This study summarizes the history of the fetal surgeries that are most commonly performed worldwide, how they started and how they evolved over time, the main validation trials and the most widely used surgical technique in each case. The main surgeries include laser photocoagulation of placental anastomoses in twin-to-twin transfusion syndrome, in utero repair of fetal myelomeningocele and fetal endotracheal occlusion in cases of congenital diaphragmatic hernia. Other surgeries and procedures, whose benefits are less clear and whose results are still somewhat controversial, such as urinary interventions in cases of lower urinary tract obstruction, cardiac procedures in cases of critical aortic stenosis, thoracoamniotic shunts for the treatment of massive pleural effusions and intrauterine resection of sacrococcygeal teratomas and pulmonary masses, are also cited. The future of fetal surgery is also assessed.

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“…Fetal Surgery-"Scar-free" Wound Healing Harrison et al (1990) and that the in utero repair of congenital anatomic lesions might potentially be expanded to include facial clefts. Fetal wounds heal with markedly reduced or no scarring .…”

Section: Gene Therapymentioning

confidence: 99%

Treatment Outcome in Cleft Lip and Palate: Issues and Perspectives

Mølsted¹

1999

Critical Reviews in Oral Biology & Medicine

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In the last 40 years, great progress has been made toward a better understanding of many aspects of the cleft lip and palate defect, but there is still a long way to go before there is agreement on the optimal treatment procedures. With regard to the primary operations, it can be stated, in a somewhat simplified form, that there are two main schools of thought in cleft treatment. One advocates early closure of the lip and palate, a procedure which imparts a high priority to early speech function. The other recommends delayed closure of the hard palate, thereby according a high priority to the growth of the maxilla A number of intercenter and multicenter studies have been carried out recently in an effort to elucidate which procedures give the best result, both esthetically and functionally. The results are ambiguous, and this has led a number of researchers to suggest that the randomized clinical trial is the only way to resolve the ambiguity, The fact that it has proved difficult to identify the optimal procedures in the field of cleft lip and palate treatment need not only be due to a less than optimal research design, a contributory factor might also be the great variability in craniofacial morphology and in the response to treatment in patients who have exactly the same cleft lip and palate diagnosis. Intensive research has made it possible to state categorically that clefts occur due to many different factors in an interplay between genetics and environment. Therefore, it is not likely that a single gene can be responsible for clefting. Since scar tissue presents many problems-for instance, impairment of growth-the reduction or prevention of scar formation has long been a desirable goal. The discovery that a fetus can heal without scar formation has led to many animal experiments. The timing of the surgical intervention on fetuses is critical, since lategestation fetuses heal with adult-like scarring. There are still many unsolved problems connected with fetal surgery, and at present prenatal surgery for repair of cleft lip and palate is not ethically defensible in humans. On the other hand, it appears that there are considerable possibilities for the reduction of human scarring after surgery with the introduction of various woundhealing medications.

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Successful Repair in Utero of a Fetal Diaphragmatic Hernia after Removal of Herniated Viscera from the Left Thorax

Cited by 273 publications

References 16 publications

Different Policies on Prenatal Ultrasound Screening Programmes and Induced Abortions Explain Regional Variations in Infant Mortality with Congenital Malformations

Different Policies on Prenatal Ultrasound Screening Programmes and Induced Abortions Explain Regional Variations in Infant Mortality with Congenital Malformations

Cirurgia fetal no contexto atual

Treatment Outcome in Cleft Lip and Palate: Issues and Perspectives

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