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Fetoscopic endoluminal tracheal occlusion

Nicola Persico, Isabella Fabietti, Fabrizio Ciralli, Valerio Gentilino, Francesco D'Ambrosi, Simona Boito, Manuela Wally Ossola, Mariarosa Colnaghi, Valentina Condò, Francesco Macchini, Ernesto Leva, Fabio Mosca, Luigi Fedele
OBJECTIVE: To report on our experience in the prenatal treatment of severe congenital diaphragmatic hernia (CDH) by fetoscopic endoluminal tracheal occlusion (FETO). METHODS: Between 2012 and 2014, FETO was performed at our center in 21 cases of CDH considered to be severe based on sonographic measurement of observed/expected lung-to-head ratio (O/E LHR) and side of the defect. We reported pre- and postoperative ultrasound findings, procedure-related complications, pregnancy outcome and survival at 1-3 years of age...
August 4, 2016: Fetal Diagnosis and Therapy
Jamila Al-Maary, Mary P Eastwood, Francesca Maria Russo, Jan A Deprest, Richard Keijzer
OBJECTIVE: To evaluate fetal survival after tracheal occlusion in fetuses with severe pulmonary hypoplasia and isolated congenital diaphragmatic hernia (CDH). BACKGROUND: Despite recent advances in neonatal intensive care, CDH still has a high mortality and morbidity. Fetoscopic endoluminal tracheal occlusion (FETO) stimulates lung growth and improves gas exchange in animal models of CDH, but the effects in humans are still under investigation. METHODS: We searched Pubmed, Cochrane, EMBASE, and Scopus databases for clinical studies on tracheal occlusion and CDH...
February 22, 2016: Annals of Surgery
Patrícia Pereira-Terra, Jan A Deprest, Ramin Kholdebarin, Naghmeh Khoshgoo, Philip DeKoninck, Anne A Boerema-De Munck, Jinxia Wang, Fuqin Zhu, Robbert J Rottier, Barbara M Iwasiow, Jorge Correia-Pinto, Dick Tibboel, Martin Post, Richard Keijzer
OBJECTIVE AND BACKGROUND: Our objective was to determine the fetal in vivo microRNA signature in hypoplastic lungs of human fetuses with severe isolated congenital diaphragmatic hernia (CDH) and changes in tracheal and amniotic fluid of fetuses undergoing fetoscopic endoluminal tracheal occlusion (FETO) to reverse severe lung hypoplasia due to CDH. METHODS: We profiled microRNA expression in prenatal human lungs by microarray analysis. We then validated this signature with real-time quantitative polymerase chain reaction in tracheal and amniotic fluid of CDH patients undergoing FETO...
December 2015: Annals of Surgery
A-G Cordier, J C Jani, M M Cannie, C Rodó, I Fabietti, N Persico, J Saada, E Carreras, M-V Senat, A Benachi
OBJECTIVE: To investigate the value of fetal stomach position in predicting postnatal outcome in left-sided congenital diaphragmatic hernia (CDH) with and without fetoscopic endoluminal tracheal occlusion (FETO). METHODS: This was a retrospective review of CDH cases that were expectantly managed or treated with FETO, assessed from May 2008 to October 2013, in which we graded, on a scale of 1-4, stomach position on the four-chamber view of the heart with respect to thoracic structures...
August 2015: Ultrasound in Obstetrics & Gynecology
S Rugolotto, L Giacomello, G El-Dalati, L Sacchetto, L Antonello, G De Luca, R Raffaelli
Temporary tracheal balloons have been shown to improve lung growth in fetuses with severe congenital diaphragmatic hernia. Fetoscopic Endoluminal Tracheal Occlusion (FETO) is performed at 26-28 weeks gestation, and then is removed in utero at 34 weeks gestation at highly specialized centers. In case of preterm labor at a hospital without a specialized team, a number of techniques have been used to remove the balloon, sometimes with death of the newborn. We have successfully performed an ultrasound-guided approach to puncture and remove the tracheal balloon in a premature infant in an emergency setting at birth...
2014: Journal of Neonatal-perinatal Medicine
Giancarlo Mari, Jan Deprest, Mauro Schenone, Scott Jackson, Jacques Samson, Brian Brocato, Danielle Tate, Ryan Sullivan, Garry White, Reddy Dhanireddy, Timothy Mandrell, Sonali Gupta, Cezary Skobowjat, Andrzej Slominski, Harris L Cohen, Natalia Schlabritz-Loutsevitch
INTRODUCTION: Percutaneous fetoscopic endoluminal reversible tracheal occlusion (FETO) was developed to prevent the pulmonary complications of fetal congenital diaphragmatic herniation. There is an urgent need to establish the closest to human translational model of FETO in order to improve fetal outcomes and to determine new clinical approaches and applications. MATERIAL AND METHODS: Seven non-human primates underwent two subsequent surgeries: the first, the FETO in the experimental group (n = 3) or sham operation in the control animals (S-FETO, n = 4) at 132-142 days of gestation (dGA); the second, the reversal of occlusion or sham operation at 162 ± 5 dGA...
2014: Fetal Diagnosis and Therapy
Thomas P Cundy, Glenn J Gardener, Chad C Andersen, Christopher P Kirby, Craig A McBride, Warwick J Teague
AIM: An estimated 140 pregnancies are diagnosed with congenital diaphragmatic hernia (CDH) in Australia and New Zealand each year, with these fetuses having a less than even chance of 1-year survival. Fetoscopic endoluminal tracheal occlusion (FETO) is a relatively new technique that offers a prenatal interventional strategy for selective cases of CDH. This is not routinely offered in Australia or New Zealand. The aim of this systematic review is to critically appraise controlled clinical trials investigating the role of FETO in moderate and severe isolated CDH and explore whether this treatment is justified within our region...
March 2014: Journal of Paediatrics and Child Health
E Doné, E Gratacos, K H Nicolaides, K Allegaert, C Valencia, M Castañon, J-M Martinez, J Jani, T Van Mieghem, A Greenough, O Gomez, P Lewi, J Deprest
OBJECTIVES: To investigate neonatal morbidity in fetuses with severe congenital diaphragmatic hernia (CDH) treated with fetoscopic endoluminal tracheal occlusion (FETO) and compare it with historical controls with less severe forms of CDH that were managed expectantly. METHODS: This was a prospective, multicenter study on neonatal outcomes and prenatal predictors in 90 FETO survivors (78 left-sided, 12 right) and 41 controls from the antenatal CDH registry with either severe or moderate hypoplasia who were managed expectantly...
July 2013: Ultrasound in Obstetrics & Gynecology
Holly L Hedrick
Congenital diaphragmatic hernia (CDH) is a congenital anomaly that presents with a broad spectrum of severity that is dependent upon components of pulmonary hypoplasia and pulmonary hypertension. While advances in neonatal care have improved the overall survival of CDH in experienced centers, mortality and morbidity remain high in a subset of CDH infants with severe CDH. Prenatal predictors have been refined for the past two decades and are the subject of another review in this issue. So far, all randomized trials comparing prenatal intervention to standard postnatal therapy have shown no benefit to prenatal intervention...
February 2013: Seminars in Pediatric Surgery
Tom Verbelen, Toni Lerut, Willy Coosemans, Paul De Leyn, Philippe Nafteux, Dirk Van Raemdonck, Jan Deprest, Herbert Decaluwé
OBJECTIVES: Preventive antireflux surgery (ARS) at the moment of congenital diaphragmatic hernia (CDH) repair has been suggested by some authors, particularly in subgroups with a liver herniated in the chest or patch requirement. We evaluated the incidence and associated factors of gastro-oesophageal reflux disease (GERD) and the need for subsequent ARS in our CDH patients. METHODS: We retrospectively reviewed our CDH database. Demographics, prenatal assessment of severity, prenatal treatment, type of repair, intraoperative findings and incidences of gastro-oesophageal reflux and ARS were recorded...
August 2013: European Journal of Cardio-thoracic Surgery
Mieke M Cannie, Anne-Gaël Cordier, Jocelyne De Laveaucoupet, Stéphanie Franchi-Abella, Maud Cagneaux, Olivier Prodhomme, Marie-Victoire Senat, Mostafa Mokhtari, Vinciane Vlieghe, Dorota Nowakowska, Alexandra Benachi, Jacques C Jani
OBJECTIVE: To evaluate the relationship of the liver-to-thoracic volume ratio (LiTR) by MRI with postnatal survival in foetuses with isolated congenital diaphragmatic hernia (CDH). METHODS: In 30 conservatively managed CDH foetuses and in 31 who underwent fetoscopic endoluminal tracheal occlusion (FETO), logistic regression analysis was used to investigate the effect on postnatal survival of the observed-to-expected (O/E) ratio of total foetal lung volume (TFLV), LiTR, gestational age at delivery, CDH side, intrathoracic position of the liver and, for those who underwent FETO, gestational age at FETO and occlusion period...
May 2013: European Radiology
T Van Mieghem, R Cruz-Martinez, K Allegaert, P Dekoninck, M Castanon, I Sandaite, F Claus, R Devlieger, E Gratacos, J Deprest
OBJECTIVE: Fetuses with congenital diaphragmatic hernia (CDH) and for whom additional ultrasound findings are abnormal typically are considered to have a dismal prognosis. Our aim was to assess the outcome of fetuses with CDH and associated intrafetal fluid effusions. METHODS: This was a retrospective bicentric cohort study on the perinatal management of fetuses with CDH and intrafetal fluid effusions. RESULTS: The incidence of effusions was 5...
January 2012: Ultrasound in Obstetrics & Gynecology
H C M L Rodrigues, J Deprest, P P v d Berg
OBJECTIVE: In this article, we reflect on whether randomized controlled trials (RCTs) are adequate for the clinical evaluation of maternal-fetal surgery for congenital diaphragmatic hernia (CDH), focusing on the role of patients' preferences in the setting up of research protocols, on the requirement of equipoise and on the concept of therapeutic misconception (TM). METHOD: We describe the conception and setting up of the tracheal occlusion (TO) to accelerate lung growth trial and analyze the ethical dilemmas faced by the research team during that time...
June 2011: Prenatal Diagnosis
Filip Claus, Inga Sandaite, Philip DeKoninck, Oscar Moreno, Rogelio Cruz Martinez, Tim Van Mieghem, Léonardo Gucciardo, Jute Richter, Katrijn Michielsen, Jonas Decraene, Roland Devlieger, Eduard Gratacos, Jan A Deprest
The role of prenatal ultrasound and magnetic resonance imaging in the diagnosis and management of congenital diaphragmatic hernia (CDH) is reviewed. Topics include morphologic imaging and vascular assessment of the developing lung, the value of imaging parameters as prognostic predictors in CDH and the role of imaging following percutaneous fetoscopic endoluminal tracheal occlusion.
2011: Fetal Diagnosis and Therapy
Luc Breysem, Anne Debeer, Filip Claus, Marijke Proesmans, Frederik De Keyzer, Paul Lewi, Karel Allegaert, Maria-Helena Smet, Jan Deprest
PURPOSE: To measure tracheal dimensions in children with congenital diaphragmatic hernia (CDH) who had undergone fetoscopic endoluminal tracheal occlusion (FETO) or were treated expectantly during gestation. MATERIALS AND METHODS: The study was approved by the local ethics committee. Computed tomography was performed in 23 patients (14 boys and nine girls) aged 1 month to 6.5 years, and the anteroposterior diameter, width, area, and perimeter of the trachea were determined...
October 2010: Radiology
E Done, K Allegaert, P Lewi, J Jani, L Gucciardo, T Van Mieghem, E Gratacos, R Devlieger, D Van Schoubroeck, J Deprest
OBJECTIVES: To predict neonatal survival and pulmonary hypertension by measurement of fetal pulmonary artery reactivity to maternal hyperoxygenation in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO). METHODS: Thirty-eight fetuses underwent FETO at around 28 weeks' gestation and the balloon was removed at 34 weeks in most cases. We performed a hyperoxygenation test and measured the lung-to-head ratio of each fetus before and after each procedure...
March 2011: Ultrasound in Obstetrics & Gynecology
S Mayer, D Kluth, H Till, J Deprest
Congenital diaphragmatic hernia (CDH) occurs sporadically with an incidence of 1:2,500 live births. Despite the progress in neonatal intensive care, CDH remains associated with a mortality of at least 30 % in isolated cases. The in essence surgically correctable defect of the diaphragm enables the prenatal herniation of abdominal organs into the thoracic cavity. The resulting abnormal development of the airways and pulmonary vessels causes neonatal respiratory insufficiency and persistent pulmonary hypertension...
December 2009: Zentralblatt Für Chirurgie
T Van Mieghem, L Gucciardo, E Doné, D Van Schoubroeck, E M Graatsma, G H A Visser, J Verhaeghe, J Deprest
OBJECTIVES: The pre-existing compression of the left ventricle in congenital diaphragmatic hernia (CDH) could be aggravated by the amplified lung growth after fetoscopic endoluminal tracheal occlusion (FETO). Our aim was to document left ventricular (LV) size and function in fetuses with isolated left-sided CDH and to document the effect of FETO on the fetal heart. METHODS: We determined cardiac axis, LV diameters, ejection fraction, shortening fraction, mitral E/A index and myocardial performance index (MPI) in 27 fetuses with isolated left-sided CDH, and compared these with values in a reference population (n = 117)...
October 2009: Ultrasound in Obstetrics & Gynecology
Mieke M Cannie, Jacques C Jani, Frederik De Keyzer, Karel Allegaert, Steven Dymarkowski, Jan Deprest
PURPOSE: To prospectively assess changes in lung volume in fetuses with isolated severe congenital diaphragmatic hernia (CDH) after fetoscopic endoluminal tracheal occlusion (FETO) compared with those in fetuses with CDH of variable severity who were expectantly managed. MATERIALS AND METHODS: Informed consent was obtained for this ethics committee-approved study. Forty fetuses with severe CDH (lung-to-head ratio < 1 and intrathoracic liver) who underwent FETO and 18 fetuses with CDH of variable severity who were expectantly managed were longitudinally followed up by using magnetic resonance (MR) imaging volume measurements...
August 2009: Radiology
Olivier Boucherat, Alexandra Benachi, Bernadette Chailley-Heu, Marie-Laure Franco-Montoya, Caroline Elie, Jelena Martinovic, Jacques R Bourbon
BACKGROUND: Pulmonary hypoplasia and persistent pulmonary hypertension account for significant mortality and morbidity in neonates with congenital diaphragmatic hernia (CDH). Global lung immaturity and studies in animal models suggest the presence of surfactant deficiency that may further complicate the pathophysiology of CDH. However, data about surfactant status in human fetuses with CDH at birth are contradictory. The lack of a chronological study of surfactant content in late pregnancy has been a significant limitation...
July 31, 2007: PLoS Medicine
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