Fetal diagnosis and therapy · 2026
Endotracheal balloon bursting: modified technique for percutaneous ultrasound-guided balloon puncture to reverse tracheal occlusion in congenital diaphragmatic hernia.
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Cruz-Martinez Rogelio, Molina-Giraldo Saulo, Gil-Pugliese Savino, Helue-Mena Antonio, Lavalle-López Oscar, Huaraz-Zuloaga Rubén, Del Pozo-Orozco Marco
Аннотация
INTRODUCTION: Fetuses with congenital diaphragmatic hernia (CDH) treated with fetal endoscopic tracheal occlusion (FETO) require a second procedure to reverse tracheal occlusion before birth. In this study, we aimed to report the feasibility and perinatal outcomes of a modified technique for ultrasound-guided balloon bursting used as a primary attempt.
METHODS: From January 2012 to December 2025 a prospective cohort of isolated CDH cases treated with FETO was included in a management protocol for balloon removal by a percutaneous balloon bursting using a 22-gauge needle in a transversal view of the fetal trachea under simultaneous 2D and color Doppler ultrasound guidance (dual imaging) to avoid vessels. The feasibility of this technique, procedure-related characteristics, complications and outcomes were evaluated.
RESULTS: During the study period, 88 (74 left-sided, and 14 right-sided) CDH were treated with FETO at a mean GA of 29.6 weeks. The balloon was removed at a mean GA of 33.8 weeks, and as an emergency procedure in up to 40.7% of the cases. Percutaneous ultrasound-guided balloon punction was feasible in 80% of the cases. Our technique was technically successful and allowed balloon rupture in up to 98.5% of the selected cases. No cases of fetal bleeding or intrauterine fetal demise after balloon removal were observed and, in all cases, a patent airway was confirmed after birth.
CONCLUSION: Implementing a modified technique for percutaneous ultrasound-guided balloon bursting is safe and feasible and allows balloon bursting avoiding the need for a second fetoscopic procedure for the reversal of FETO.
METHODS: From January 2012 to December 2025 a prospective cohort of isolated CDH cases treated with FETO was included in a management protocol for balloon removal by a percutaneous balloon bursting using a 22-gauge needle in a transversal view of the fetal trachea under simultaneous 2D and color Doppler ultrasound guidance (dual imaging) to avoid vessels. The feasibility of this technique, procedure-related characteristics, complications and outcomes were evaluated.
RESULTS: During the study period, 88 (74 left-sided, and 14 right-sided) CDH were treated with FETO at a mean GA of 29.6 weeks. The balloon was removed at a mean GA of 33.8 weeks, and as an emergency procedure in up to 40.7% of the cases. Percutaneous ultrasound-guided balloon punction was feasible in 80% of the cases. Our technique was technically successful and allowed balloon rupture in up to 98.5% of the selected cases. No cases of fetal bleeding or intrauterine fetal demise after balloon removal were observed and, in all cases, a patent airway was confirmed after birth.
CONCLUSION: Implementing a modified technique for percutaneous ultrasound-guided balloon bursting is safe and feasible and allows balloon bursting avoiding the need for a second fetoscopic procedure for the reversal of FETO.