The Outcomes and Lung Changes of Fetoscopic Endoluminal Tracheal Occlusion in Fetus with Diaphragmatic Hernia: A Single-Center Experience in Japan.

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.