Abstract
Isolated congenital diaphragmatic hernia (CDH) with intrathoracic liver and lung-head-ratio <1 (LHR) is associated with high neonatal mortality due to pulmonary hypoplasia and hypertension. We described a percutaneous technique for FETO with a balloon and report on the evolution of results in a consecutive series of 20 patients. Within two years time-period, FETO was done between 26–28 weeks in 20 fetuses with LCDH, meeting the criteria above. Under feto-maternal analgesia and immobilization, endoluminal balloon (GVB16, Cathnet) occlusion between carina and vocal cords was performed, using a 3.0 mm sheath and a 1.2mm fetoscope (11505, Storz). Under general, epidural or local anesthesia (resp. n=5;13;2) the balloon could always be successfully positioned and no maternal complications occurred. Mean operation time was 18 min and GA at delivery 33.4 weeks. PPROM occurred in 20% at <28 resp. 30% at <32 wks. Airways were restored either perinatally (n=9) or prenatally (n=11). Neonatal (7d) survival resp. at discharge were 70%(14/20) and 60%(12/20). Late (>7 d) losses were due to pulmonary hypoplasia in one, but in a second baby care was withdrawn for a prenatally missed chromosomal anomaly, however with adequate ventilatory function. During that period 17 contemporary controls of LCDH were evaluated, with an antenatal loss rate of 29% (5/17 TOP) and survival at discharge of 8 % (1/12). There seems to be a trend for decreasing operation time, PPROM rates, lesser risk for preterm delivery and potentially better results with prenatal versus perinatal balloon retrieval (44 vs.73 %). FETO is reproducible, minimally invasive to the mother, but carries a risk for PPROM. With increasing experience, incidence of PPROM and preterm delivery drop. Airways can be restored prior to birth, allowing vaginal delivery and further management at the referring center. FETO improved prognosis in highly selected cases with LCDH as compared to contemporary controls.
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Jani, J., Gratacos, E., Davenport, M. et al. 182 Improving Results with Percutaneous Fetal Endoscopic Tracheal Occlusion (FETO) for Severe Left Congenital Diaphragmatic Hernia.. Pediatr Res 58, 385 (2005). https://doi.org/10.1203/00006450-200508000-00211
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DOI: https://doi.org/10.1203/00006450-200508000-00211