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https://www.readbyqxmd.com/read/29466789/two-port-fetoscopic-repair-of-myelomeningocele-in-fetal-lambs
#1
Lucie Guilbaud, Charles Garabedian, Nathalie Roux, Stéphanie Friszer, Ferdinand Dhombres, Raphaël Vialle, Zoobia Shah, Bettina Bessières, Federico Di Rocco, Michel Zerah, Jean-Marie Jouannic
OBJECTIVE: The aim of this study was to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) repair with a running single suture using a 2-port access in the sheep model. METHODS: Eighteen fetuses underwent surgical creation of a MMC defect at day 75. Fetuses were then randomized into 3 groups. Four fetuses remained untreated (control group). In the other 14 fetuses, a prenatal repair was performed at day 90: 7 fetuses had an open repair (oMMC), and 7 fetuses had a fetoscopic repair (fMMC) using a single-layer running suture through a 2-port access...
February 21, 2018: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/29462812/survival-rate-without-brain-abnormalities-on-postnatal-ultrasonography-among-monochorionic-twins-after-fetoscopic-laser-photocoagulation-for-selective-intrauterine-growth-restriction-with-concomitant-oligohydramnios
#2
Keisuke Ishii, Seiji Wada, Mayumi Takano, Masahiko Nakata, Takeshi Murakoshi, Haruhiko Sago
INTRODUCTION: We aimed to clarify the survival rate without brain abnormalities (BA) after fetoscopic laser photoco-agulation (FLP) for monochorionic diamniotic twin gestations (MCDA) with selective intrauterine growth restriction (sIUGR) accompanied by abnormal umbilical artery (UA) Doppler waveforms and isolated oligohydramnios in the sIUGR twin. MATERIALS AND METHODS: This retrospective study included 52 cases that underwent FLP. The main outcome was survival rate without BA of the twins at age 28 days...
February 20, 2018: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/29436080/fetoscopic-laser-photocoagulation-for-twin-twin-transfusion-syndrome
#3
Haruhiko Sago, Keisuke Ishii, Rika Sugibayashi, Katsusuke Ozawa, Masahiro Sumie, Seiji Wada
The aim of this study was to review fetoscopic laser photocoagulation (FLP), which ablates placental vascular anastomoses to treat twin-twin transfusion syndrome (TTTS). A review of studies reporting on the procedures, outcomes, complications and nonconventional applications of FLP for TTTS was conducted. FLP has been established as the primary treatment for monochorionic twin pregnancy associated with TTTS at 16-26 weeks. FLP is the only therapy that directly addresses the underlying pathophysiology. The recent technique modification of FLP, referred to as the 'Solomon technique', induces selective coagulation to connect the anastomoses ablation sites and has been introduced to reduce residual anastomoses...
February 13, 2018: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/29380497/pprom-is-a-collateral-effect-of-improvement-in-perinatal-outcomes-following-fetoscopic-coagulation-of-chorionic-vessels-for-ttts-a-retrospective-observational-study-of-1092-cases
#4
J Stirnemann, F Djaafri, A Kim, I Mediouni, L Bussieres, E Spaggiari, C Veluppillai, A Lapillonne, E Kermorvant, J-F Magny, C Colmant, Y Ville
OBJECTIVE: Preterm premature rupture of membranes (PPROM) is a leading complication following fetoscopic laser coagulation (FLC) for twin-twin transfusion syndrome (TTTS). Our primary objective was to describe the impact of improvements in surgical technique on survival and rate of PPROM over time. The secondary objective was to assess potential risk factors for PPROM. DESIGN AND SETTING: Single center retrospective observational study. POPULATION: 1092 consecutive cases of TTTS operated by FLC, between 2000 and 2016, with a 6...
January 30, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29341044/antenatal-medical-therapies-to-improve-lung-development-in-congenital-diaphragmatic-hernia
#5
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
https://www.readbyqxmd.com/read/29340812/partial-amniotic-carbon-dioxide-insufflation-paci-during-minimally-invasive-fetoscopic-interventions-on-fetuses-with-spina-bifida-aperta
#6
Miriam Ziemann, Rolf Fimmers, Anastasiia Khaleeva, Rainer Schürg, Markus A Weigand, Thomas Kohl
BACKGROUND: Percutaneous partial amniotic carbon dioxide insufflation (PACI) is one of the most important means for improving visualization during minimally invasive fetoscopic surgery of fetal spina bifida. The purpose of the present study was to analyze maternal and fetal safety aspects of PACI in a recent patient cohort and to present management improvements. METHODS: PACI under general materno-fetal anesthesia was performed during 65 interventions for fetoscopic patch coverage of fetal spina bifida aperta between 21 + 0 and 29 + 1 weeks of gestation...
January 16, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29338992/subsequent-fertility-pregnancy-and-gynecologic-outcomes-after-fetoscopic-laser-therapy-for-twin-twin-transfusion-syndrome-compared-to-normal-monochorionic-twin-gestations
#7
Simen Vergote, Liesbeth Lewi, Willem Gheysen, Luc de Catte, Roland Devlieger, Jan Deprest
BACKGROUND: An improved survival and quality of life for neonatal survivors after fetoscopic laser therapy (FLC) for twin-twin transfusion syndrome (TTTS) has been reported. However, little is known about the medium-term maternal effects after FLC with respect to reproductive and gynecologic outcomes. OBJECTIVE: To document reproductive, obstetric, gynecologic and psychological outcomes in women who underwent FLC for TTTS. STUDY DESIGN: Monocentric controlled study on consecutive women who underwent FLC for TTTS between 2007 and 2013 at the University Hospitals Leuven (cases; n=198)...
January 12, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29314321/percutaneous-fetoscopic-closure-of-large-open-spina-bifida-using-a-bilaminar-skin-substitute
#8
Denise A Lapa Pedreira, Gregório L Acacio, Rodrigo T Gonçalves, Renato Augusto M Sá, Reynaldo A Brandt, Ramen Chmait, Eftichia Kontopoulos, Ruben A Quintero
OBJECTIVE: We have previously described our percutaneous fetoscopic technique for the treatment of open spina bifida (OSB). However, approximately 20-30% of OSB defects are too large to allow primary skin closure. We hereby describe a modification of our standard technique using a bilaminar skin substitute to allow closure of such large spinal defects. The aim of this study was to report our clinical experience with the use of a bilaminar skin substitute and a percutaneous fetoscopic technique for the prenatal closure of large spina bifida defects...
January 4, 2018: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29239485/comparison-of-umbilical-cord-occlusion-methods-radiofrequency-ablation-versus-laser-photocoagulation
#9
Mira Abdel-Sattar, Andrew H Chon, Arlyn Llanes, Lisa M Korst, Joseph G Ouzounian, Ramen H Chmait
OBJECTIVE: To compare outcomes between 2 umbilical cord occlusion (UCO) methods: radiofrequency ablation (RFA) versus fetoscopic-guided laser photocoagulation. METHODS: Retrospective study of all monochorionic diamniotic multiple gestations that underwent UCO with RFA (preferred after 2014) or laser (preferred before 2014). In bivariate analysis, patients treated with RFA were compared with laser. Risk factors for intrauterine fetal demise (IUFD) and 30-day survival of the co-twin were identified, and multiple logistic models were fitted to examine whether the UCO method was associated with these outcomes...
December 14, 2017: Prenatal Diagnosis
https://www.readbyqxmd.com/read/29215525/low-fidelity-simulator-for-the-standardized-training-of-fetoscopic-meningomyelocele-repair
#10
Michael A Belfort, William E Whitehead, Andrey Bednov, Alireza A Shamshirsaz
BACKGROUND: Fetoscopic meningomyelocele repair in a gas-filled uterus is a new technique performed in very few centers. There are few opportunities as well as ethical prohibitions on the initial development and subsequent refinement of innovative fetal surgery techniques in humans, and using an animal model is both very expensive and logistically difficult. METHOD: We developed a low-fidelity endoscopic fetal surgery simulation using a plastic doll and pieces of chicken breast to simulate a fetal meningomyelocele, and a polyurethane ball to simulate a gas-filled uterus, along with a standard endoscopy system and instruments...
January 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29169875/current-and-future-antenatal-management-of-isolated-congenital-diaphragmatic-hernia
#11
REVIEW
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...
November 21, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29125525/early-postnatal-bladder-function-in-fetoscopic-myelomeningocele-repair-patients
#12
Gene O Huang, Michael A Belfort, William E Whitehead, Oluyinka O Olutoye, Jonathan Castillo, Heidi Castillo, Kathryn K Ostermaier, Chester J Koh, Duong D Tu
PURPOSE: Prenatal repair of myelomeningocele (MMC) via hysterotomy has demonstrated neurosurgical and motor benefits, when compared to postnatal repairs. Urologic benefits, however, remain to be seen. The purpose of this study was to review early postnatal bladder function in patients undergoing a novel endoscopic approach for MMC repair using an exteriorized uterus. METHODS: A prospective urologic assessment of patients undergoing fetoscopic MMC repair and receiving subsequent care at our facility, was performed...
October 20, 2017: Journal of Pediatric Rehabilitation Medicine
https://www.readbyqxmd.com/read/29122542/twin-twin-transfusion-syndrome-what-we-have-learned-from-clinical-trials
#13
REVIEW
Fatiha Djaafri, Julien Stirnemann, Imen Mediouni, Claire Colmant, Yves Ville
Monochorionic twin pregnancies are at increased risk for adverse outcome compared to dichorionic twin pregnancies and singletons. Monochorionic-specific complications include twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence, single intrauterine fetal demise and its consequences on the co-twin, and selective intrauterine growth restriction. Whereas the natural history of monochorionic-specific complications carries a high risk of fetal death or severe neurologic disability, a framework now exists, based on well-designed clinical trials, for optimal treatment of these entities...
November 6, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29101642/prenatal-surgery-for-spina-bifida-a-therapeutic-dilemma-proceedings-of-the-shine-conference-belfast
#14
Mano Shanmuganathan, Deborah A Sival, Kelly-Ann Eastwood, Katie Morris, Jacqueline Cartmill, Axel Heep, Janusz Bohosiewicz, Agnieszka Pastuszka, Alyson Hunter, Amanda Ali, Roy McConnell, Darach Crimmins, Fergal Malone, Carolyn Bailie, Jan Deprest, Cathy McKillop, Zarko Alfirevic, Fionnuala McAuliffe, Stephen Ong
This is a transcript of a scientific conference on the subject of prenatal surgery for spina bifida. It represents the views of three patients, an obstetrician, a postnatal neurosurgeon, a neonatologist, a paediatric neurologist, two surgeons who practice open spina bifida foetal surgery, a fetoscopic surgeon and an obstetrician experienced in randomised trials and systematic reviews. Implications for current practice and recommendations for future research are also discussed in detail.
November 3, 2017: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/29055131/case-report-of-staphylococcus-epidermidis-maternal-sepsis-and-chorioamnionitis-following-fetoscopy
#15
Gabriel Levin, Roy Zigron
A patient aged 28 years (gravida 5 para 3) who was at 21 weeks of a monochorionic diamniotic pregnancy, underwent fetoscopic laser ablation of placental blood vessels owing to stage-3 twin-to-twin transfusion syndrome (Figure 1). Ultrasonography on post-operative day 1 demonstrated marked improvement of both embryo urinary bladder filling and Doppler blood flow measurements. This article is protected by copyright. All rights reserved.
October 21, 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/29027307/transient-amniotic-fluid-leakage-after-fetoscopic-laser-photocoagulation-for-twin-twin-transfusion-syndrome
#16
Shiyo Ota, Keisuke Ishii, Hiroshi Kawamura, Aki Mabuchi, Ryo Yamamoto, Shusaku Hayashi, Takeshi Kanagawa, Nobuaki Mitsuda
AIM: Iatrogenic premature rupture of membrane (PROM) is one of the major complications related to fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). However, amniotic fluid leakage (AFL) sometimes spontaneously disappears. This study evaluated the incidence and clinical characteristics of transient AFL after FLP. METHODS: We retrospectively reviewed pregnancies that underwent FLP for TTTS at a single center. Patients with apparent AFL within 2 weeks after FLP were divided into two groups: transient AFL, defined by the disappearance of fluid leakage within a week; and PROM, if AFL persisted continuously for more than a week or premature birth occurred, including miscarriage, within a week of the first symptom of AFL...
October 13, 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/28977797/evaluation-of-magnetic-resonance-imaging-safety-and-imaging-issues-associated-with-the-occlusion-balloon-used-during-fetoscopic-endoluminal-tracheal-occlusion
#17
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
https://www.readbyqxmd.com/read/28964685/shunt-based-interventions-why-how-and-when-to-place-a-shunt
#18
REVIEW
Mark P Johnson, R Douglas Wilson
The broad categories of surgical fetal therapy can be separated into either open surgical techniques or minimally invasive endoscopic/ultrasound-guided techniques that require only puncture of the uterus with single or multiple small ports. Benefits of fetoscopic or ultrasound-guided fetal intervention include decreased uterine irritability, decreased incidence of preterm labor, and avoidance of risks associated with hysterotomy and commitment to cesarean delivery for future pregnancies. Fetal abnormalities potentially amenable to ultrasound-guided drainage techniques include thoracic fluid-filled lesions and lower urinary tract obstruction...
December 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28925589/recurrent-twin-twin-transfusion-syndrome-rttts-and-twin-anemia-polycythemia-sequence-taps-after-fetoscopic-laser-surgery-fls-size-of-the-cannula-does-matter
#19
Roopali Donepudi, Joost Akkermans, Lovepreet Mann, Frans J Klumper, Johanna M Middeldorp, Enrico Lopriore, Kenneth J Moise, Michael Bebbington, Anthony Johnson, Dick Oepkes, Ramesha Papanna
OBJECTIVES: Optimal outcomes after fetoscopic laser surgery (FLS) for twin-twin transfusion (TTTS) depend on the successful completion of ablation of all placental anastomoses. Our objective was to determine the incidence and risk factors for the occurrence of recurrent TTTS (rTTTS) or twin anemia-polycythemia sequence (TAPS) after FLS, and focusing on the impact of different diameters of the cannula. METHODS: A secondary analysis of prospectively collected data of 666 consecutive patients undergoing laser surgery for TTTS from 2 centers was performed...
September 19, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28910784/fetal-surgery-for-myelomeningocele-a-systematic-review-and-meta-analysis-of-outcomes-in-fetoscopic-versus-open-repair
#20
Sandra K Kabagambe, Guy W Jensen, Yue Julia Chen, Melissa A Vanover, Diana L Farmer
BACKGROUND/OBJECTIVES: The Management of Myelomeningocele (MMC) Study (MOMS) showed that prenatal repair of MMC resulted in improved neurological outcomes but was associated with high rates of obstetrical complications. This study compares outcomes of open and fetoscopic MMC repair. DATA SOURCES: PubMed and Embase studies reporting outcomes of fetal MMC repair published since the completion of the MOMS. RESULTS: We analyzed 11 studies and found no difference in mortality or the rate of shunt placement for hydrocephalus...
September 15, 2017: Fetal Diagnosis and Therapy
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