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Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: indications, outcomes, and future directions.
[congenital diaphragmatic hernia]
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
.
Diseases
Validation
Diseases presenting
"poor outcomes"
symptom
cholangiocarcinoma
congenital diaphragmatic hernia
esophageal carcinoma
trochlear dysplasia
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