Fetoscopic endoluminal tracheal occlusion and reestablishment of fetal airways for congenital diaphragmatic hernia.
Por:
Van der Veeken L, Russo FM, De Catte L, Gratacós E, Benachi A, Ville Y, Nicolaides K, Berg C, Gardener G, Persico N, Bagolan P, Ryan G, Belfort MA and Deprest J
Publicada:
8 may 2018
Ahead of Print:
8 may 2018
Resumen:
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.
Filiaciones:
Van der Veeken L:
1Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, and Clinical Department of Obstetrics and Gynaecology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
Russo FM:
1Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, and Clinical Department of Obstetrics and Gynaecology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
De Catte L:
1Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, and Clinical Department of Obstetrics and Gynaecology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
Gratacós E:
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium
3BCNatal - Barcelona Center for MaternaleFetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
Benachi A:
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium
4Department of Obstetrics, Gynaecology and Reproductive Medicine, Hôpital Antoine-Béclère, University Paris Sud, Clamart, France
European Reference Network on Rare and Inherited Congenital Anomalies ERNICA, Rotterdam, The Netherlands
Ville Y:
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium
5Fetal Medicine Unit, Obstetrics and Fetal Medicine Department, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Nicolaides K:
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium
6Harris Birthright Centre, King's College Hospital, London, UK
Berg C:
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium
7Division of Fetal Surgery, Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
8Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
Gardener G:
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium
9Mater Health Services, Mater Research UQ, Brisbane, Australia
Persico N:
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium
10Department of Obstetrics and Gynecology, L. Mangiagalli, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
Bagolan P:
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium
11Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165 Rome, Italy
European Reference Network on Rare and Inherited Congenital Anomalies ERNICA, Rotterdam, The Netherlands
Ryan G:
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium
12Fetal Medicine Unit, Mt Sinai Hospital, University of Toronto, Toronto, Canada
Belfort MA:
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium
13Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas USA
Deprest J:
1Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, and Clinical Department of Obstetrics and Gynaecology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium
European Reference Network on Rare and Inherited Congenital Anomalies ERNICA, Rotterdam, The Netherlands
Open Access
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