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Fetoscopic endoluminal tracheal occlusion

Lennart van der Veeken, Francesca M Russo, Johannes van der Merwe, David Basurto, Dyuti Sharma, Tram Nguyen, Marie P Eastwood, Namesh Khoshgoo, Jaan Toelen, Karel Allegaert, Philip Dekoninck, Stuart B Hooper, Richard Keijzer, Paolo DE Coppi, Jan Deprest
Congenital diaphragmatic hernia is rare birth defect, which can be easily corrected after birth. The main problem is that herniation of viscera during fetal development impairs lung development, leading to a 30 % mortality and significant morbidity. In isolated cases the outcome can be accurately predicted prenatally by medical imaging. Cases with a poor prognosis can be treated before birth; clinically this is by fetoscopic endoluminal tracheal occlusion. Obstruction of the airways triggers lung growth. This procedure and is currently being evaluated in a global clinical trial for left sided cases; right sided cases with poor prognosis are offered the procedure clinically...
February 23, 2018: Minerva Pediatrica
Aidan Kashyap, Philip DeKoninck, Kelly Crossley, Marta Thio, Graeme Polglase, Francesca Maria Russo, Jan Deprest, Stuart Hooper, Ryan Hodges
Congenital diaphragmatic hernia (CDH) is a birth defect characterized by failed closure of the diaphragm, allowing abdominal viscera to herniate into the thoracic cavity and subsequently impair pulmonary and vascular development. Despite improving standardized postnatal management, there remains a population of severe CDH for whom postnatal care falls short. In these severe cases, antenatal surgical intervention (fetoscopic endoluminal tracheal occlusion [FETO]) may improve survival; however, FETO increases the risk of preterm delivery, is not widely offered, and still fails in half of cases...
January 16, 2018: American Journal of Perinatology
Francesca Maria Russo, Paolo De Coppi, Karel Allegaert, Jaan Toelen, Lennart van der Veeken, George Attilakos, Mary Patrice Eastwood, Anna Louise David, Jan Deprest
Congenital diaphragmatic hernia is surgically correctable, yet the poor lung development determines mortality and morbidity. In isolated cases the outcome may be predicted prenatally by medical imaging. Cases with a poor prognosis could be treated before birth. However, prenatal modulation of lung development remains experimental. Fetoscopic endoluminal tracheal occlusion triggers lung growth and is currently being evaluated in a global clinical trial. Prenatal transplacental sildenafil administration may in due course be a therapeutic approach, reducing the occurrence of persistent pulmonary hypertension, either alone or in combination with fetal surgery...
December 2017: Seminars in Fetal & Neonatal Medicine
Teresa Victoria, Ann M Johnson, N Scott Adzick, Holly L Hedrick, Frank G Shellock
INTRODUCTION: Congenital diaphragmatic hernias can be successfully treated by fetoscopic tracheal occlusion (FETO), a minimally invasive procedure that may improve postnatal survival. The endoluminal balloon utilized for FETO contains a metallic component that may pose possible risks for the fetus and mother related to the use of magnetic resonance imaging (MRI). The objective of this study is to evaluate MRI-related imaging and safety issues (magnetic field interactions, heating, and artifacts) for the occlusion balloon used in FETO...
October 5, 2017: Fetal Diagnosis and Therapy
Eva Van Ginderdeuren, Karel Allegaert, Herbert Decaluwe, Jan Deprest, Anne Debeer, Marijke Proesmans
BACKGROUND: Congenital diaphragmatic hernia (CDH) is an abnormal development of the diaphragm leading to high neonatal mortality and morbidity. Beyond the neonatal period, prospective data on overall long-term outcome in CDH survivors is scarce. In particular, for those treated with fetoscopic endoluminal tracheal occlusion (FETO), a promising new technique to increase survival chances for severe cases, the outcomes are even less documented. AIM: To prospectively document the clinical outcome of CDH at 1 year including FETO-treated infants in relation to ante- and postnatal variables...
2017: Neonatology
Elisa Done, Leonardo Gucciardo, Tim Van Mieghem, Koen Devriendt, Karel Allegaert, Paul Brady, Roland Devlieger, Luc De Catte, Liesbeth Lewi, Jan Deprest
OBJECTIVE: Fetoscopic endoluminal tracheal occlusion (FETO) may improve outcome of severe isolated congenital diaphragmatic hernia (iCDH). We aimed to identify any discrepancy between initial assessment at the referring hospital and the evaluation at the fetal surgery center, and to document parental decisions following counseling for fetal surgery. DESIGN: Single center retrospective study on patients with presumed iCDH either referred for assessment and counseling or referred for fetal surgery...
September 2017: Prenatal Diagnosis
Julio A Jiménez, Elisenda Eixarch, Philip DeKoninck, João R Bennini, Roland Devlieger, Cleisson F Peralta, Eduard Gratacos, Jan Deprest
BACKGROUND: Isolated congenital diaphragmatic hernia defect allows viscera to herniate into the chest, competing for space with the developing lungs. At birth, pulmonary hypoplasia leads to respiratory insufficiency and persistent pulmonary hypertension that is lethal in up to 30% of patients. Antenatal measurement of lung size and liver herniation can predict survival after birth. Prenatal intervention aims at stimulating lung development, clinically achieved by percutaneous fetal endoscopic tracheal occlusion under local anesthesia...
July 2017: American Journal of Obstetrics and Gynecology
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...
2017: 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...
December 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
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