The lung‐to‐head ratio and fetoscopic temporary tracheal occlusion: prediction of survival in severe left congenital diaphragmatic hernia

Keller, Rodolfo; Glidden, David V.; Paek, Bettina; Goldstein, Ruth B.; Feldstein, Vickie A.; Callen, P W; Filly, Roy A.; Albanese, Craig T.

doi:10.1002/uog.44

Cited by 62 publications

(39 citation statements)

References 23 publications

(32 reference statements)

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“…Le LHR est le produit des deux diamètres orthogonaux du poumon droit (en cas de hernie gauche) au niveau des oreillettes, divisé par le périmètre crânien. Ce rapport est maintenant validé comme témoin de l'HP dans les hernies diaphragmatiques gauches [43,44]. Une large étude rétrospective portant sur 184 foetus atteints a montré que lorsque le foie était en position intrathoracique, le taux de survie global était de 50 %.…”

Section: é Chographie-2dunclassified

Évaluation du poumon fœtal en imagerie

Pasquali¹,

Potier²,

Gorincour³

2008

Gynécologie Obstétrique & Fertilité

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Section: é Chographie-2dunclassified

Évaluation du poumon fœtal en imagerie

Pasquali¹,

Potier²,

Gorincour³

2008

Gynécologie Obstétrique & Fertilité

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“…Information on response to therapy would improve medical decisions and parental counseling. So far, the best prediction is provided by lung size before therapy or the relative increase in lung volume after therapy [14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

Changes in Lung Tissue Perfusion in the Prediction of Survival in Fetuses with Congenital Diaphragmatic Hernia Treated with Fetal Endoscopic Tracheal Occlusion

Cruz‐Martínez

Moreno-Álvarez²,

Hernández‐Andrade³

et al. 2010

Fetal Diagn Ther

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Objective: To assess the impact of lung perfusion by fractional moving blood volume (FMBV) for the prediction of survival in fetuses with congenital diaphragmatic hernia (CDH) treated with fetal endoscopic tracheal occlusion (FETO). Study Design: Lung perfusion by FMBV (%) and the observed/expected lung-to-head ratio (o/e LHR) were evaluated 1 day before and 7–14 days after FETO in a cohort of 62 CDH fetuses, and their isolated and combined values to predict survival was assessed. Results: Preoperative lung perfusion did not show association with survival. However, after FETO, an increase in 30% of the preoperative lung FMBV and an increase in 50% of the LHR was significantly associated with the probability of survival. A model combining the changes in FMBV and o/e LHR after therapy allowed discrimination of cases with poor (10% survival), moderate (40–70% survival) and very good prognosis (100% survival). Conclusion:Changes in lung tissue perfusion, evaluated by FMBV after FETO, improved the prediction of survival in fetuses with CDH.

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“…In conclusion, while LHR remains the strongest predictive index, Doppler measure- the identification of cases with high probability of responding to fetal therapy is of high relevance for parents' counseling and decisions. So far, the best parameter to establish the severity of CDH and predict the chances of survival after FETO is the observed to expected lung-tohead ratio (LHR) in combination with the presence or absence of intrathoracic liver herniation [5][6][7][8] . However, the survival rates after FETO in fetuses with intermediate LHR values range from 45 to 55%.…”

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confidence: 99%

Prognostic Value of Pulmonary Doppler to Predict Response to Tracheal Occlusion in Fetuses with Congenital Diaphragmatic Hernia

et al. 2010

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Pulmonary Doppler may play an important role in the prediction of survival and postnatal morbidity in fetuses with congenital diaphragmatic hernia treated with fetoscopic tracheal occlusion (FETO). Spectral Doppler indexes such as pulsatility index and peak early diastolic reversed flow could help to refine the selection of fetuses that might benefit from fetal therapy. When combined with lung-to-head ratio (LHR), these Doppler indices allow to discriminate cases with moderate-to-high survival rates from fetuses with extremely low chances to survive after FETO. In addition, they discriminate groups with a high or low risk of serious neonatal morbidity in surviving fetuses. After therapy, the combined evaluation of the relative increase of LHR with the increase in lung tissue perfusion by power Doppler seems to improve the prediction of fetal survival. In conclusion, while LHR remains the strongest predictive index, Doppler measurements allow to substantially improve the accuracy in the prediction of the chances of survival of fetuses with congenital diaphragmatic hernia treated with FETO.

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The lung‐to‐head ratio and fetoscopic temporary tracheal occlusion: prediction of survival in severe left congenital diaphragmatic hernia

Abstract: Objectives To evaluate the reliability of sonographic lung-to-head ratio (LHR) measurement as a predictor of survival in fetuses with

Cited by 62 publications

References 23 publications

Évaluation du poumon fœtal en imagerie

Évaluation du poumon fœtal en imagerie

Changes in Lung Tissue Perfusion in the Prediction of Survival in Fetuses with Congenital Diaphragmatic Hernia Treated with Fetal Endoscopic Tracheal Occlusion

Prognostic Value of Pulmonary Doppler to Predict Response to Tracheal Occlusion in Fetuses with Congenital Diaphragmatic Hernia

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