[Fetoscopic tracheal occlusion for the treatment of severe congenital diaphragmatic hernia: preliminary results]. / Oclusión traqueal fetoscópica (FETO) para el tratamiento de la hernia diafragmática congénita severa: resultados preliminares.

OBJECTIVES: To evaluate survival and lung growth in fetuses with severe congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO) compared with control fetuses and to analyze possible complications of the anesthetic techniques used. PATIENTS AND METHODS: This prospective study was performed on fetuses with CDH. FETO was undertaken before the 29th week of gestation on fetuses with a lung-to-head ratio (LHR) less than 1. FETO was not performed on fetuses with an LHR between 1.0 and 1.5 or those with an LHR less than 1 where consent was not given. Lung growth was monitored by means of LHR. FETO was performed under fetal intramuscular anesthesia and maternal epidural anesthesia and sedation with remifentanil. RESULTS: Seventeen fetuses were included in the study. FETO was performed on 11 fetuses and was effective in 9. The median percentage difference between LHR at diagnosis and prior to FETO was 1.15% (P=.183); between diagnosis and before removing the balloon, the difference was 130.5% (P=.003); and between diagnosis and before delivery, 90.18% (P=.003). In the control group (n=6), the median percentage difference between LHR at diagnosis and before delivery was 49.25% (P=.028). No significant hemodynamic or respiratory changes occurred in either mother or fetus during fetoscopy. All the fetuses in the control group died; 45.5% of those in the FETO group survived. CONCLUSIONS: The use of FETO in cases of CDH appears to increase survival and lung growth. Fetal anesthesia in association with maternal epidural anesthesia and sedation makes it possible to place and remove the endotracheal balloon via fetoscopy with acceptable maternal comfort and without notable complications.

Oclusión traqueal fetoscópica (FETO) para el tratamiento de lahernia diafragmática congénita severa: resultados preliminares / Fetoscopic tracheal occlusion for the treatment of severe congenital diaphragmatic hernia: preliminary results

OBJETIVOS: Evaluar la supervivencia y crecimientopulmonar de fetos con hernia diafragmática congénitasevera (HDCs) tratados con oclusión traqueal fetoscópica(FETO) comparado con aquellos en que no se realizóy analizar posibles complicaciones de las técnicas anestésicas.PACIENTES Y MÉTODOS: Estudio prospectivo en fetoscon HDCs. FETO fue realizada antes de la 29 SG a fetoscon un lung head ratio (LHR) < 1. No se realizó FETO alos pacientes con LHR entre 1,0 y 1,5 o con LHR<1 queno dieron consentimiento. El crecimiento pulmonar fuemonitorizado con el LHR. Las fetoscopias se realizaronbajo anestesia intramuscular fetal asociada a anestesiaepidural y sedación materna con remifentanilo.RESULTADOS: Se incluyeron 17 fetos. En 11 se realizóFETO que fue efectiva en 9, la mediana de la diferenciade porcentajes del LHR respecto al diagnóstico fue1,15% (p = 0,183) previamente FETO, 130,5% (p =0,003) antes de retirar el balón y 90,18% (p = 0,003)antes del parto. En los “no FETO” (n=6) la diferencia deporcentajes del LHR antes del parto respecto al diagnósticofue 49,25% (p = 0,028). Durante las fetoscopiasno se produjeron cambios significativos hemodinámicoso respiratorios maternos ni fetales. En el grupo "FETO" 45,5% sobrevivieron mientras que en el "no FETO" todos murieron. CONCLUSIONES: FETO en la HDCs parece aumentar lasupervivencia y el crecimiento pulmonar. La anestesiafetal asociada a anestesia epidural y sedación maternapermiten colocar y retirar el balón endotraqueal fetoscópicamentecon buena confortabilidad materna sin complicacionesimportantes (AU)

OBJECTIVES: To evaluate survival and lung growth infetuses with severe congenital diaphragmatic hernia(CDH) treated with fetoscopic tracheal occlusion(FETO) compared with control fetuses and to analyzepossible complications of the anesthetic techniques used.PATIENTS AND METHODS: This prospective study wasperformed on fetuses with CDH. FETO was undertakenbefore the 29th week of gestation on fetuses with a lungto-head ratio (LHR) less than 1. FETO was notperformed on fetuses with an LHR between 1.0 and 1.5or those with an LHR less than 1 where consent was notgiven. Lung growth was monitored by means of LHR.FETO was performed under fetal intramuscularanesthesia and maternal epidural anesthesia andsedation with remifentanil.RESULTS: Seventeen fetuses were included in thestudy. FETO was performed on 11 fetuses and waseffective in 9. The median percentage difference betweenLHR at diagnosis and prior to FETO was 1.15%(P=.183); between diagnosis and before removing theballoon, the difference was 130.5% (P=.003); andbetween diagnosis and before delivery, 90.18% (P=.003).In the control group (n=6), the median percentagedifference between LHR at diagnosis and before deliverywas 49.25% (P=.028). No significant hemodynamic orrespiratory changes occurred in either mother or fetusduring fetoscopy. All the fetuses in the control groupdied; 45.5% of those in the FETO group survived. CONCLUSIONS: The use of FETO in cases of CDHappears to increase survival and lung growth. Fetalanesthesia in association with maternal epidural anesthesiaand sedation makes it possible to place and remove theendotracheal balloon via fetoscopy with acceptablematernal comfort and without notable complications (AU)