Fetal diagnosis and therapy · 2025
The Outcomes and Lung Changes of Fetoscopic Endoluminal Tracheal Occlusion in Fetus with Diaphragmatic Hernia: A Single-Center Experience in Japan.
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Muromoto Jin, Ozawa Katsusuke, Sugibayashi Rika, Amari Shoichiro, Wada Seiji, Kanamori Yutaka, Ito Yushi, Sago Haruhiko
Аннотация
INTRODUCTION: The aim of this study was to evaluate the outcomes with lung changes of fetoscopic endoluminal tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH).
METHODS: Between 2014 and 2023, we performed FETO for severe or moderate left-sided CDH with the Kitano grade 3 stomach position. We analyzed the pre- and postoperative ultrasound findings, pregnancy outcomes, and survival rates at 6 months.
RESULTS: Twenty-five patients were analyzed. The median gestational age at balloon insertion was 29.1 (range: 27.1-31.8) weeks. The median gestational age at delivery was 35.7 (range: 30.7-38.7) weeks. Pulmonary hypertension was observed in 71% (15/21) of the cases. The 6-month survival rate was 40% (10/25). The post-FETO observed-to-expected lung area-to-head circumference ratio (o/e LHR) and differences between pre- and post-FETO values were significantly higher in survivors than in infants who died (p < 0.01 and p < 0.01, respectively), but pre-FETO values were not. The post-FETO cutoff value associated with the 6-month survival was 33.8%, and that of the difference between pre- and post-FETO o/e LHR was 7.8% (area under the curve = 0.91 and 0.86, respectively).
CONCLUSIONS: FETO can lead to an increased o/e LHR in some but not all CDH fetuses, reflecting fetal lung growth, and be associated with a survival when it exceeds the threshold.
METHODS: Between 2014 and 2023, we performed FETO for severe or moderate left-sided CDH with the Kitano grade 3 stomach position. We analyzed the pre- and postoperative ultrasound findings, pregnancy outcomes, and survival rates at 6 months.
RESULTS: Twenty-five patients were analyzed. The median gestational age at balloon insertion was 29.1 (range: 27.1-31.8) weeks. The median gestational age at delivery was 35.7 (range: 30.7-38.7) weeks. Pulmonary hypertension was observed in 71% (15/21) of the cases. The 6-month survival rate was 40% (10/25). The post-FETO observed-to-expected lung area-to-head circumference ratio (o/e LHR) and differences between pre- and post-FETO values were significantly higher in survivors than in infants who died (p < 0.01 and p < 0.01, respectively), but pre-FETO values were not. The post-FETO cutoff value associated with the 6-month survival was 33.8%, and that of the difference between pre- and post-FETO o/e LHR was 7.8% (area under the curve = 0.91 and 0.86, respectively).
CONCLUSIONS: FETO can lead to an increased o/e LHR in some but not all CDH fetuses, reflecting fetal lung growth, and be associated with a survival when it exceeds the threshold.