Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia

Indications, outcomes, and future directions

Rodrigo Ruano, Raheel A. Ali, Parin Patel, Darrell Cass, Oluyinka Olutoye, Michael A. Belfort

Research output: Contribution to journalReview article

14 Citations (Scopus)

Abstract

: In the present study, we review the indications, technical aspects, preliminary results, risks, and clinical implications of fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) performed outside the United States and its potential future directions in this country and globally. : Congenital diaphragmatic hernia occurs in approximately 1 in 2500 live births and results in high neonatal morbidity and mortality, largely associated with the severity of pulmonary hypoplasia and pulmonary arterial hypertension. With the advent of prenatal imaging, CDH can be diagnosed before birth, and in utero treatment is now available in some centers. The prognosis of CDH can be evaluated by assessing the fetal lung size, the degree of liver herniation, and the fetal pulmonary vasculature in isolated forms of CDH. These parameters help classify fetuses as having mild, moderate, severe, or extremely severe isolated CDH. Severe and extremely severe diaphragmatic hernias have poor outcomes and thus are candidates for innovative therapies such as FETO. : Fetal endoscopic tracheal occlusion is usually performed between 26 and 30 weeks' gestation. In utero, an endoscope is passed through the fetal mouth and down to the carina; the balloon is deployed just above the carina. After the procedure, ultrasound surveillance every 2 weeks ensures the balloon's structural integrity and measures the fetal pulmonary response. At approximately 34 weeks' gestation, the balloon is deflated and removed. Fetal endoscopic tracheal occlusion is thought to improve outcomes by decreasing mortality and allowing more rapid neonatal stabilization. Ultimately, the goal of FETO is to minimize pulmonary hypoplasia and pulmonary arterial hypertension. Following delivery, neonates still require diaphragm repair. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to evaluate the different imaging modalities available for determining prognosis in fetuses with congenital diaphragmatic hernias, identify the indications for fetal endoscopic tracheal occlusion, and compare the potential benefits and complications of fetal endoscopic tracheal occlusion.

Original languageEnglish (US)
Pages (from-to)147-158
Number of pages12
JournalObstetrical and Gynecological Survey
Volume69
Issue number3
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Lung
Pulmonary Hypertension
Fetus
Pregnancy
Investigational Therapies
Diaphragmatic Hernia
Endoscopes
Family Physicians
Live Birth
Infant Mortality
Diaphragm
Congenital Diaphragmatic Hernias
Direction compound
Mouth
Parturition
Newborn Infant
Morbidity
Physicians
Mortality
Liver

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia : Indications, outcomes, and future directions. / Ruano, Rodrigo; Ali, Raheel A.; Patel, Parin; Cass, Darrell; Olutoye, Oluyinka; Belfort, Michael A.

In: Obstetrical and Gynecological Survey, Vol. 69, No. 3, 01.01.2014, p. 147-158.

Research output: Contribution to journalReview article

Ruano, Rodrigo ; Ali, Raheel A. ; Patel, Parin ; Cass, Darrell ; Olutoye, Oluyinka ; Belfort, Michael A. / Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia : Indications, outcomes, and future directions. In: Obstetrical and Gynecological Survey. 2014 ; Vol. 69, No. 3. pp. 147-158.
@article{49efd6de04fd42bb9f76bb338720b590,
title = "Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: Indications, outcomes, and future directions",
abstract = ": In the present study, we review the indications, technical aspects, preliminary results, risks, and clinical implications of fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) performed outside the United States and its potential future directions in this country and globally. : Congenital diaphragmatic hernia occurs in approximately 1 in 2500 live births and results in high neonatal morbidity and mortality, largely associated with the severity of pulmonary hypoplasia and pulmonary arterial hypertension. With the advent of prenatal imaging, CDH can be diagnosed before birth, and in utero treatment is now available in some centers. The prognosis of CDH can be evaluated by assessing the fetal lung size, the degree of liver herniation, and the fetal pulmonary vasculature in isolated forms of CDH. These parameters help classify fetuses as having mild, moderate, severe, or extremely severe isolated CDH. Severe and extremely severe diaphragmatic hernias have poor outcomes and thus are candidates for innovative therapies such as FETO. : Fetal endoscopic tracheal occlusion is usually performed between 26 and 30 weeks' gestation. In utero, an endoscope is passed through the fetal mouth and down to the carina; the balloon is deployed just above the carina. After the procedure, ultrasound surveillance every 2 weeks ensures the balloon's structural integrity and measures the fetal pulmonary response. At approximately 34 weeks' gestation, the balloon is deflated and removed. Fetal endoscopic tracheal occlusion is thought to improve outcomes by decreasing mortality and allowing more rapid neonatal stabilization. Ultimately, the goal of FETO is to minimize pulmonary hypoplasia and pulmonary arterial hypertension. Following delivery, neonates still require diaphragm repair. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to evaluate the different imaging modalities available for determining prognosis in fetuses with congenital diaphragmatic hernias, identify the indications for fetal endoscopic tracheal occlusion, and compare the potential benefits and complications of fetal endoscopic tracheal occlusion.",
author = "Rodrigo Ruano and Ali, {Raheel A.} and Parin Patel and Darrell Cass and Oluyinka Olutoye and Belfort, {Michael A.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1097/OGX.0000000000000045",
language = "English (US)",
volume = "69",
pages = "147--158",
journal = "Obstetrical and Gynecological Survey",
issn = "0029-7828",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia

T2 - Indications, outcomes, and future directions

AU - Ruano, Rodrigo

AU - Ali, Raheel A.

AU - Patel, Parin

AU - Cass, Darrell

AU - Olutoye, Oluyinka

AU - Belfort, Michael A.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - : In the present study, we review the indications, technical aspects, preliminary results, risks, and clinical implications of fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) performed outside the United States and its potential future directions in this country and globally. : Congenital diaphragmatic hernia occurs in approximately 1 in 2500 live births and results in high neonatal morbidity and mortality, largely associated with the severity of pulmonary hypoplasia and pulmonary arterial hypertension. With the advent of prenatal imaging, CDH can be diagnosed before birth, and in utero treatment is now available in some centers. The prognosis of CDH can be evaluated by assessing the fetal lung size, the degree of liver herniation, and the fetal pulmonary vasculature in isolated forms of CDH. These parameters help classify fetuses as having mild, moderate, severe, or extremely severe isolated CDH. Severe and extremely severe diaphragmatic hernias have poor outcomes and thus are candidates for innovative therapies such as FETO. : Fetal endoscopic tracheal occlusion is usually performed between 26 and 30 weeks' gestation. In utero, an endoscope is passed through the fetal mouth and down to the carina; the balloon is deployed just above the carina. After the procedure, ultrasound surveillance every 2 weeks ensures the balloon's structural integrity and measures the fetal pulmonary response. At approximately 34 weeks' gestation, the balloon is deflated and removed. Fetal endoscopic tracheal occlusion is thought to improve outcomes by decreasing mortality and allowing more rapid neonatal stabilization. Ultimately, the goal of FETO is to minimize pulmonary hypoplasia and pulmonary arterial hypertension. Following delivery, neonates still require diaphragm repair. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to evaluate the different imaging modalities available for determining prognosis in fetuses with congenital diaphragmatic hernias, identify the indications for fetal endoscopic tracheal occlusion, and compare the potential benefits and complications of fetal endoscopic tracheal occlusion.

AB - : In the present study, we review the indications, technical aspects, preliminary results, risks, and clinical implications of fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) performed outside the United States and its potential future directions in this country and globally. : Congenital diaphragmatic hernia occurs in approximately 1 in 2500 live births and results in high neonatal morbidity and mortality, largely associated with the severity of pulmonary hypoplasia and pulmonary arterial hypertension. With the advent of prenatal imaging, CDH can be diagnosed before birth, and in utero treatment is now available in some centers. The prognosis of CDH can be evaluated by assessing the fetal lung size, the degree of liver herniation, and the fetal pulmonary vasculature in isolated forms of CDH. These parameters help classify fetuses as having mild, moderate, severe, or extremely severe isolated CDH. Severe and extremely severe diaphragmatic hernias have poor outcomes and thus are candidates for innovative therapies such as FETO. : Fetal endoscopic tracheal occlusion is usually performed between 26 and 30 weeks' gestation. In utero, an endoscope is passed through the fetal mouth and down to the carina; the balloon is deployed just above the carina. After the procedure, ultrasound surveillance every 2 weeks ensures the balloon's structural integrity and measures the fetal pulmonary response. At approximately 34 weeks' gestation, the balloon is deflated and removed. Fetal endoscopic tracheal occlusion is thought to improve outcomes by decreasing mortality and allowing more rapid neonatal stabilization. Ultimately, the goal of FETO is to minimize pulmonary hypoplasia and pulmonary arterial hypertension. Following delivery, neonates still require diaphragm repair. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to evaluate the different imaging modalities available for determining prognosis in fetuses with congenital diaphragmatic hernias, identify the indications for fetal endoscopic tracheal occlusion, and compare the potential benefits and complications of fetal endoscopic tracheal occlusion.

UR - http://www.scopus.com/inward/record.url?scp=84897012660&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84897012660&partnerID=8YFLogxK

U2 - 10.1097/OGX.0000000000000045

DO - 10.1097/OGX.0000000000000045

M3 - Review article

VL - 69

SP - 147

EP - 158

JO - Obstetrical and Gynecological Survey

JF - Obstetrical and Gynecological Survey

SN - 0029-7828

IS - 3

ER -