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Gynecol Surg. 2018;15(1):9. doi: 10.1186/s10397-018-1041-9. Epub 2018 May 8.

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

Author information

1
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.
2
TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium, Leuven, Belgium.
3
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.
4
4Department of Obstetrics, Gynaecology and Reproductive Medicine, Hôpital Antoine-Béclère, University Paris Sud, Clamart, France.
5
European Reference Network on Rare and Inherited Congenital Anomalies "ERNICA", Rotterdam, The Netherlands.
6
5Fetal Medicine Unit, Obstetrics and Fetal Medicine Department, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
7
6Harris Birthright Centre, King's College Hospital, London, UK.
8
7Division of Fetal Surgery, Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.
9
8Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany.
10
9Mater Health Services, Mater Research UQ, Brisbane, Australia.
11
10Department of Obstetrics and Gynecology, "L. Mangiagalli," Fondazione IRCCS "Ca' Granda" - Ospedale Maggiore Policlinico, Milan, Italy.
12
11Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165 Rome, Italy.
13
12Fetal Medicine Unit, Mt Sinai Hospital, University of Toronto, Toronto, Canada.
14
13Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas USA.

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.

KEYWORDS:

CDH; Congenital diaphragmatic hernia; FETO; Fetal endoluminal tracheal occlusion; Fetal surgery; Fetoscopy

Conflict of interest statement

LVDV, FMR, LDC, and JD are in the Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, and Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium. EG, AB, YV, KN, CB, GG, NP, PB, GR, MAB, and JD are members of the TOTAL (Tracheal Occlusion To Accelerate Lung Growth Trial) Consortium. EG is head of the Barcelona Center for Maternale Fetal 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. AB is head of the Department of Obstetrics, Gynaecology and Reproductive Medicine, Hôpital Antoine-Béclère, University Paris Sud, Clamart, France. YV is head of the Fetal Medicine Unit, Obstetrics and Fetal Medicine Department, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. KN is head of the Fetal Medicine Center, Harris Birthright Centre, King’s College Hospital, London, UK. CB is head of the Division of Fetal Surgery, Department of Obstetrics and Prenatal Medicine, University of Bonn, and Department of Obstetrics and Gynecology, University of Cologne, Germany. GG is head of the Mater Health Services, Mater Research UQ, Brisbane, Australia. NP is in the Department of Obstetrics and Gynecology “L. Mangiagalli,” Fondazione IRCCS “Ca′ Granda” - Ospedale Maggiore Policlinico, Milan, Italy. PB is head of Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy. GR is head of the Fetal Medicine Unit, Mt. Sinai Hospital, and University of Toronto, Toronto, Canada. MAB is head of the Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, Texas, USA. AB, PB, and JD are members of the European Reference Network on Rare and Inherited Congenital Anomalies “ERNICA.”Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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