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https://www.readbyqxmd.com/read/29881553/a-case-of-mirror-syndrome-caused-by-hydrops-fetalis-after-fetoscopic-laser-photocoagulation
#1
Emi Kino, Yohei Maki, Masanao Ohhashi, Seishi Furukawa, Takatsugu Maeda, Hiroshi Sameshima
Fetoscopic laser photocoagulation (FLP) of placental anastomoses is a well-established procedure for twin-to-twin transfusion syndrome that improves fetal outcome with rare maternal complications. However, fetal hydrops can develop even after FLP, and mirror syndrome can occur, indicating that both the fetal and maternal courses should be monitored after FLP.
June 2018: Clinical Case Reports
https://www.readbyqxmd.com/read/29876992/fetoscopic-two-layers-closure-of-open-neural-tube-defects
#2
C Giné, S Arévalo, N Maíz, C Rodó, S Manrique, A Poca, J A Molino, E Carreras, M López
PURPOSE: Fetoscopic technique for closure of open neural tube defects (NTD) remains controversial as the use of patches or the single layer closure are believed to stay far from the standards of a good neurosurgical reconstruction. We describe hereby a fetoscopic two-layer closure technique (myofascial and skin) for the treatment of NTD in 5 patients and our preliminary anatomical outcome at birth. MATERIAL AND METHODS: With the exteriorized uterus and three 10Fr ports, the placode is dissected from the surrounding tissue and de-tethered, removing the cystic tissue...
June 6, 2018: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29874646/preoperative-ultrasound-prediction-of-essential-landmarks-for-successful-fetoscopic-laser-treatment-of-twin-twin-transfusion-syndrome
#3
Jena L Miller, Dana M Block-Abraham, Karin J Blakemore, Ahmet A Baschat
INTRODUCTION: The insertion site of the fetoscope for laser occlusion (FLOC) treatment of twin-twin transfusion syndrome (TTTS) determines the likelihood of treatment success. We assessed a standardized preoperative ultrasound approach for its ability to identify critical landmarks for successful FLOC. METHODS: Three surgeons independently performed preoperative ultrasound and deduced the likely orientation of the intertwin membrane (ITM) and vascular equator (VE) based on the sites of the cord insertion, the lie of the donor, and the size discordance between twins...
June 6, 2018: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/29803315/fetoscopic-therapy-for-severe-pulmonary-hypoplasia-in-congenital-diaphragmatic-hernia-a-first-in-prenatal-regenerative-medicine-at-mayo-clinic
#4
Rodrigo Ruano, Denise B Klinkner, Karthik Balakrishnan, Victoria A Novoa Y Novoa, Norman Davies, Dean D Potter, William A Carey, Christopher E Colby, Amy B Kolbe, Katherine W Arendt, Leal Segura, Hans P Sviggum, Maureen A Lemens, Abimbola Famuyide, Andre Terzic
OBJECTIVE: To introduce the prenatal regenerative medicine service at Mayo Clinic for fetal endoscopic tracheal occlusion (FETO) care for severe congenital diaphragmatic hernia (CDH). PATIENTS AND METHODS: Two cases of prenatal management of severe CDH with FETO between January and August 2017 are reported. Per protocol, FETO was offered for life-threatening severe CDH at between 26 and 29 weeks' gestation. Regenerative outcome end point was fetal lung growth. Gestational age at procedure and maternal and perinatal outcomes were additional monitored parameters...
May 15, 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29770571/using-poly-l-lactic-acid-and-poly-%C3%A9-caprolactone-blends-to-fabricate-self-expanding-watertight-and-biodegradable-surgical-patches-for-potential-fetoscopic-myelomeningocele-repair
#5
Rigwed Tatu, Marc Oria, Sarah Pulliam, Lorenzo Signey, Marepalli B Rao, Jose L Peiro, Chia-Ying Lin
Our study focuses on the development and characterization of a self-expanding, watertight and biodegradable patch for fetoscopic myelomeningocele (MMC) prenatal repair. We fabricated poly(l-lactic acid) (PLA) and poly(ɛ-caprolactone) (PCL) blend films by solution casting. Formulation c with average glass transition temperature of 37.6 ± 1.2°C was chosen for temporospatial recovery. Favorable results from surface studies reflected homogeneous dispersion of polymers in the blend. The cytotoxicity was studied in human foreskin fibroblasts...
May 16, 2018: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
https://www.readbyqxmd.com/read/29770109/fetoscopic-endoluminal-tracheal-occlusion-and-reestablishment-of-fetal-airways-for-congenital-diaphragmatic-hernia
#6
Lennart Van der Veeken, Francesca Maria Russo, Luc De Catte, Eduard Gratacos, Alexandra Benachi, Yves Ville, Kypros Nicolaides, Christoph Berg, Glenn Gardener, Nicola Persico, Pietro Bagolan, Greg Ryan, Michael A Belfort, Jan Deprest
Background: Congenital diaphragmatic hernia (CDH) is a congenital anomaly with high mortality and morbidity mainly due to pulmonary hypoplasia and hypertension. Temporary fetal tracheal occlusion to promote prenatal lung growth may improve survival. Entrapment of lung fluid stretches the airways, leading to lung growth. Methods: Fetal endoluminal tracheal occlusion (FETO) is performed by percutaneous sono-endoscopic insertion of a balloon developed for interventional radiology...
2018: Gynecological Surgery
https://www.readbyqxmd.com/read/29750436/fetal-blood-gas-values-during-fetoscopic-myelomeningocele-repair-performed-under-carbon-dioxide-insufflation
#7
Ahmet A Baschat, Edward S Ahn, Jamie Murphy, Jena L Miller
BACKGROUND: Fetoscopic myelomeningocele (MMC) repair is performed with intrauterine carbon dioxide (CO2 ) insufflation. While lamb experiments have shown significant fetal acidemia following CO2 insufflation corresponding information for human pregnancies is not available. CASES: We performed umbilical venous cord blood sampling in three patients during fetoscopic MMC repair at 25+1, 25+3 and 24+1 weeks gestation. Fetal venous pH at the beginning of CO2 insufflation were 7...
May 10, 2018: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29742660/management-of-labor-and-delivery-after-fetoscopic-repair-of-an-open-neural-tube-defect
#8
Jaden R Kohn, Vibha Rao, Allison A Sellner, Dina Sharhan, Jimmy Espinoza, Alireza A Shamshirsaz, William E Whitehead, Michael A Belfort, Magdalena Sanz Cortes
OBJECTIVE: To report labor, delivery, and neonatal outcomes in a cohort of women delivering neonates who had undergone fetoscopic neural tube defect repair. METHODS: We conducted a retrospective cohort study from April 2014 to January 2018. All patients met Management of Myelomeningocele Study eligibility criteria. We included patients with completed second-trimester fetoscopic neural tube defect repair (laparotomy, uterine exteriorization, and minimally invasive access through two or three uterine ports) followed by standardized management of labor and delivery at our institution...
June 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29740832/perinatal-outcomes-of-single-fetal-survivor-after-fetal-intervention-for-complicated-monochorionic-twins
#9
Mallory Hoffman, Mounira Habli, Roopali Donepudi, Noemi Boring, Anthony Johnson, Kenneth J Moise, Ramesha Papanna
OBJECTIVE: To compare perinatal outcomes between acute single fetal demise following FLP to planned selective reduction (SR) in complicated monochorionic (MC) twin pregnancies. METHODS: This was a secondary analysis of prospectively collected data in complicated MC twin pregnancies from two fetal centers from 2011-2016. Group 1 included women undergoing FLP for TTTS who experienced a single fetal demise within 24 hours of the procedure. Group 2 consisted of women undergoing planned SR with TTTS, and Group 3 SR for indications other than TTTS...
May 9, 2018: Prenatal Diagnosis
https://www.readbyqxmd.com/read/29728142/intermittent-fetal-heart-rate-monitoring-using-a-fetoscope-or-hand-held-doppler-in-rural-tanzania-a-randomized-controlled-trial
#10
Paschal Francis Mdoe, Hege L Ersdal, Estomih R Mduma, Jeffrey M Perlman, Robert Moshiro, Peter T Wangwe, Hussein Kidanto
BACKGROUND: Neonatal mortality is a global challenge, with an estimated 1.3 million intrapartum stillbirths in 2015. The majority of these were found in low resource settings with limited options to intrapartum fetal heart monitoring devices. This trial compared frequency of abnormal fetal heart rate (FHR) detection and adverse perinatal outcomes (i.e. fresh stillbirths, 24-h neonatal deaths, admission to neonatal care unit) among women intermittently assessed by Doppler or fetoscope in a rural low-resource setting...
May 4, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29661165/midwives-perceptions-on-using-a-fetoscope-and-doppler-for-fetal-heart-rate-assessments-during-labor-a-qualitative-study-in-rural-tanzania
#11
Paschal Francis Mdoe, Hege Langli Ersdal, Estomih Mduma, Robert Moshiro, Hussein Kidanto, Columba Mbekenga
BACKGROUND: The Doppler is thought to be more comfortable and effective compared to the fetoscope for assessing the fetal heart rate (FHR) during labor. However, in a rural Tanzanian hospital, midwives who had easy access to both devices mostly used fetoscope. This study explored midwives' perception of factors influencing their preference for using either a Pinard fetoscope or a FreePlay wind-up Doppler for intermittent FHR monitoring. METHODS: Midwives who had worked for at least 6 months in the labor ward were recruited...
April 16, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29630059/model-surgical-training-skills-acquisition-in-fetoscopic-laser-photocoagulation-of-monochorionic-diamniotic-twin-placenta-using-realistic-simulators
#12
Tuangsit Wataganara, Arundhati Gosavi, Katika Nawapun, Pradip D Vijayakumar, Nisarat Phithakwatchara, Mahesh Choolani, Lin Lin Su, Arijit Biswas, Citra N Z Mattar
Fetoscopic laser coagulation of arterio-venous anastomoses (AVA) in a monochorionic placenta is the standard of care for twin-twin transfusion syndrome (TTTS), but is technically challenging and can lead to significant complications. Acquiring and maintaining the necessary surgical skills require consistent practice, a critical caseload, and time. Training on realistic surgical simulators can potentially shorten this steep learning curve and enables several proceduralists to acquire procedure-specific skills simultaneously...
March 21, 2018: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/29608113/3d-virtual-broncoscopy-before-feto-procedure-in-a-fetus-with-severe-isolated-left-congenital-diaphragmatic-hernia
#13
Gabriele Tonni, Rodrigo Ruano, Renato Sà, Fernando Maia Peixoto Filho, Jorge Lopes, Heron Werner
INTRODUCTION: Congenital diaphragmatic hernia (CDH) is a life-threatening event in severe forms and fetuses affected may benefit from in utero treatment by fetoscopic endotracheal occlusion (FETO). MATERIALS AND METHODS: Application of 3D virtual bronchoscopy in a case of severe, isolated, left CDH before performing FETO procedure at 27 week's gestation is reported. RESULTS: The 3D virtual imaging of the fetal trachea was technically useful in planning the real FETO procedure...
April 2018: Fetal and Pediatric Pathology
https://www.readbyqxmd.com/read/29582948/-advances-in-fetal-therapy-in-complicated-monochorionic-pregnancies-and-in-severe-congenital-diaphragmatic-hernia-five-years-experience
#14
Yuval Gielchinsky, Dan V Valsky, Nili Yanai, Firas J Abdeljawad, Mazen A Muhaisen, Dan Arbell, Yehuda Ginosar, Orna Ben-Yosef, Orite Winograd, Benjamin Bar-Oz, Simcha Yagel, Smadar Eventov-Friedman
INTRODUCTION: : Minimally invasive fetal therapeutic procedures reduce the morbidity and mortality in monochorionic (MC) twins and in fetuses with congenital diaphragmatic hernia (CDH). MC pregnancies share their blood systems due to communicating vessels over their single placenta and may develop specific complications: Twin-to-Twin transfusion syndrome (TTTS), Selective intrauterine growth restriction (sIUGR), Twin Anemia-Polycythemia Sequence (TAPS), Twin Reverse Arterial Perfusion Syndrome (TRAP) or anomalies in one...
March 2018: Harefuah
https://www.readbyqxmd.com/read/29577352/retinoic-acid-and-tracheal-occlusion-for-diaphragmatic-hernia-treatment-in-rabbit-fetuses
#15
Amélie Delabaere, Loïc Blanchon, Karen Coste, Gael Clairefond, Corinne Belville, Pierre Blanc, Geoffroy Marceau, Vincent Sapin, Denis Gallot
INTRODUCTION: Lung hypoplasia and pulmonary arterial hypertension (PAH) in congenital diaphragmatic hernia (DH) lead to a high perinatal mortality. Although sustained fetoscopic tracheal occlusion (TO) improves lung development, a major side effect is abnormal pneumocyte differentiation. This study evaluated the potential ability of intra-tracheal retinoic acid (RA) administration to reduce adverse effects of sustained TO in a rabbit model of DH. METHODS: A left diaphragmatic defect was created on d23 in time-dated pregnant rabbits...
March 25, 2018: Prenatal Diagnosis
https://www.readbyqxmd.com/read/29533957/in-utero-partial-exchange-transfusion-combined-with-in-utero-blood-transfusion-for-prenatal-management-of-twin-anemia-polycythemia-sequence
#16
Mert Ozan Bahtiyar, Emre Ekmekci, Emine Demirel, Roxanna A Irani, Joshua A Copel
Monochorionic twin pregnancies are at risk of unique complications due to placental sharing and vascular connections between placental territories assigned for each twin. Twin anemia-polycythemia sequence (TAPS) is an infrequent but potentially dangerous complication of abnormal placental vascular connections. TAPS occurs due to very-small-caliber (< 1 mm) abnormal placental vascular connections which lead to chronic anemia in the donor twin and polycythemia in the recipient twin. TAPS may occur spontaneously or following fetoscopic laser photocoagulation of communicating placental vessels for twin-twin transfusion syndrome...
March 13, 2018: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/29489502/updates-in-fetal-spina-bifida-repair
#17
Yair J Blumenfeld, Michael A Belfort
PURPOSE OF REVIEW: To examine updates in fetal spina bifida surgical repair, as well as promising results emerging from translational medicine. RECENT FINDINGS: Although the Management of Myelomeningocele Study sponsored by the National Institutes of Health helped establish the neonatal benefits of prenatal spina bifida repair via uterine hysterotomy, also known as 'open' fetal surgery, fetoscopic approaches may yield better maternal and obstetric outcomes. SUMMARY: Spina bifida is a severe congenital malformation associated with significant neonatal and childhood morbidity and mortality...
April 2018: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29487889/probabilistic-visual-and-electromagnetic-data-fusion-for-robust-drift-free-sequential-mosaicking-application-to-fetoscopy
#18
Marcel Tella-Amo, Loic Peter, Dzhoshkun I Shakir, Jan Deprest, Danail Stoyanov, Juan Eugenio Iglesias, Tom Vercauteren, Sebastien Ourselin
The most effective treatment for twin-to-twin transfusion syndrome is laser photocoagulation of the shared vascular anastomoses in the placenta. Vascular connections are extremely challenging to locate due to their caliber and the reduced field-of-view of the fetoscope. Therefore, mosaicking techniques are beneficial to expand the scene, facilitate navigation, and allow vessel photocoagulation decision-making. Local vision-based mosaicking algorithms inherently drift over time due to the use of pairwise transformations...
April 2018: Journal of Medical Imaging
https://www.readbyqxmd.com/read/29479945/antenatal-management-of-congenital-diaphragmatic-hernia-today-and-tomorrow
#19
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 life 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 is currently being evaluated in a global clinical trial for left sided cases; right sided cases with poor prognosis are offered the procedure clinically...
June 2018: Minerva Pediatrica
https://www.readbyqxmd.com/read/29466789/two-port-fetoscopic-repair-of-myelomeningocele-in-fetal-lambs
#20
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
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