The plug-unplug sequence: An important step to achieve type II pneumocyte maturation in the fetal lamb model

Flageole, Hélène; Evrard, V.; Piedboeuf, Bruno; Laberge, Jean-Martin; Lerut, T.; Deprest, Jan

doi:10.1016/s0022-3468(98)90451-1

Cited by 162 publications

(101 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, even after correction for gestational age at birth, early prenatal balloon removal improved the chances of survival. In animal experiments, cyclical or temporary occlusion has been shown to improve lung maturation 26,27,31 . This might also be the case clinically, although early morbidity parameters were unaffected by prenatal balloon removal.…”

Section: Discussionmentioning

confidence: 99%

“…The FETO procedure has been described in detail 22,23,28 . Briefly it consists of the percutaneous fetoscopic insertion of a balloon into the fetal trachea, which in general is performed at approximately 26-28 (range, [23][24][25][26][27][28][29][30][31][32][33] weeks' gestation. The balloon is preferentially removed in utero at approximately 34 weeks by tracheoscopy or ultrasound-guided puncture.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of neonatal morbidity in fetuses with severe isolated congenital diaphragmatic hernia undergoing fetoscopic tracheal occlusion

Doné

Gratacós

Nicolaides

et al. 2013

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Predictors of neonatal morbidity in fetuses with severe isolated congenital diaphragmatic hernia undergoing fetoscopic tracheal occlusion

Doné

Gratacós

Nicolaides

et al. 2013

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

“…This idea of blocking the airway emerged from an experiment of nature in patients with congenital high airway obstruction syndrome resulting in big polyalveolar lungs [50]. Previous research has shown that tracheal occlusion can indeed cause an increase in lung growth [51,52] and removing the balloon before birth has shown to be necessary for a better maturation of the lung by decreasing the apoptosis of the alveolar type 2 cells, which produce surfactant, an essential compound for lung function [53]. So far, FETO has been shown to improve survival rate in high-risk CDH patients, but at the cost of increased morbidity and premature delivery [54][55][56].…”

Section: Treatment Of Pulmonary Vascular Defects In Cdhmentioning

confidence: 99%

Pulmonary vascular development in congenital diaphragmatic hernia

et al. 2018

View full text Add to dashboard Cite

Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly characterised by a diaphragmatic defect, persistent pulmonary hypertension (PH) and lung hypoplasia. The relative contribution of these three elements can vary considerably in individual patients. Most affected children suffer primarily from the associated PH, for which the therapeutic modalities are limited and frequently not evidence based. The vascular defects associated with PH, which is characterised by increased muscularisation of arterioles and capillaries, start to develop early in gestation. Pulmonary vascular development is integrated with the development of the airway epithelium. Although our knowledge is still incomplete, the processes involved in the growth and expansion of the vasculature are beginning to be unravelled. It is clear that early disturbances of this process lead to major pulmonary growth abnormalities, resulting in serious clinical challenges and in many cases death in the newborn. Here we provide an overview of the current molecular pathways involved in pulmonary vascular development. Moreover, we describe the abnormalities associated with CDH and the potential therapeutic approaches for this severe abnormality. Normal pulmonary vascular developmentHuman lung development can be divided into different stages based on histology, starting with the embryonic stage at 4 weeks of gestation, followed by the pseudoglandular stage in which branching of the lung buds continues. During the canalicular stage, starting at ∼16 weeks of gestation, the terminal bronchioli are formed. From 24 weeks of gestation until term, the saccular stage, airspaces widen and alveoli are formed. During the alveolar stage, which persists into the postnatal period up to 3 years of age, maturation of the airways occurs [1]. Concomitant with the expansion of the airways is the adaptation of the microvasculature to optimise the exchange of oxygen and carbon dioxide between the blood and the airways. We and others have shown that very early in lung development pulmonary vessels are present and connected to the systemic circulation. The vasculature develops in close relation with the airways and is a rate-limiting factor in branching morphogenesis [2][3][4]. This implies that the pulmonary vasculature plays an important role in lung development. The formation of new blood vessels primarily occurs through

show abstract

“…In brief, when sustained until birth, despite lung growth, airway epithelial maturation is compromised. In utero reversal of occlusion (clinically translated as a plug-unplug sequence) experimentally achieved morphologically better lung maturation (Flageole et al, 1998). Nelson later demonstrated that best results were obtained with a protocol of 47 h of occlusion alternated with 1 h of release.…”

Section: Consequences Of Prenatal Assessment and Interventions Improvmentioning

confidence: 99%

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

et al. 2008

View full text Add to dashboard Cite

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.

show abstract

The plug-unplug sequence: An important step to achieve type II pneumocyte maturation in the fetal lamb model

Cited by 162 publications

References 15 publications

Predictors of neonatal morbidity in fetuses with severe isolated congenital diaphragmatic hernia undergoing fetoscopic tracheal occlusion

Predictors of neonatal morbidity in fetuses with severe isolated congenital diaphragmatic hernia undergoing fetoscopic tracheal occlusion

Pulmonary vascular development in congenital diaphragmatic hernia

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

Contact Info

Product

Resources

About