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. Reversal of the occlusion to induce lung maturation can be performed by fetoscopy, transabdominal puncture, tracheoscopy, or by postnatal removal if all else fails.Results: FETO and balloon removal have been shown safe in experienced hands. This paper deals with the technical aspects of balloon insertion and removal. While FETO is invasive, it has minimal maternal risks yet can cause preterm birth potentially offsetting its beneficial effects.Conclusion: For left-sided severe and moderate CDH, the procedure is considered investigational and is currently being evaluated in a global randomized clinical trial (https://www.totaltrial.eu/). The procedure can be clinically offered to fetuses with severe right-sided CDH.

Van der Veeken, L., Russo, F.m., De Catte, L., Gratacos, E., Benachi, A., Ville, Y., et al. (2018). Fetoscopic endoluminal tracheal occlusion and reestablishment of fetal airways for congenital diaphragmatic hernia. GYNECOLOGICAL SURGERY, 15(1) [10.1186/s10397-018-1041-9].

Fetoscopic endoluminal tracheal occlusion and reestablishment of fetal airways for congenital diaphragmatic hernia

Bagolan P.;
2018-01-01

Abstract

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. Reversal of the occlusion to induce lung maturation can be performed by fetoscopy, transabdominal puncture, tracheoscopy, or by postnatal removal if all else fails.Results: FETO and balloon removal have been shown safe in experienced hands. This paper deals with the technical aspects of balloon insertion and removal. While FETO is invasive, it has minimal maternal risks yet can cause preterm birth potentially offsetting its beneficial effects.Conclusion: For left-sided severe and moderate CDH, the procedure is considered investigational and is currently being evaluated in a global randomized clinical trial (https://www.totaltrial.eu/). The procedure can be clinically offered to fetuses with severe right-sided CDH.
2018
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/20 - CHIRURGIA PEDIATRICA E INFANTILE
English
FETO
Fetal endoluminal tracheal occlusion
CDH
Congenital diaphragmatic hernia
Fetal surgery
Fetoscopy
Van der Veeken, L., Russo, F.m., De Catte, L., Gratacos, E., Benachi, A., Ville, Y., et al. (2018). Fetoscopic endoluminal tracheal occlusion and reestablishment of fetal airways for congenital diaphragmatic hernia. GYNECOLOGICAL SURGERY, 15(1) [10.1186/s10397-018-1041-9].
Van der Veeken, L; Russo, Fm; De Catte, L; Gratacos, E; Benachi, A; Ville, Y; Nicolaides, K; Berg, C; Gardener, G; Persico, N; Bagolan, P; Ryan, G; Belfort, Ma; Deprest, J
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/274342
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