Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;46(12):2598-2604.
doi: 10.1111/jog.14504. Epub 2020 Sep 28.

Feasibility and outcomes of fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: A Japanese experience

Seiji Wada  1 , Katsusuke Ozawa  1 , Rika Sugibayashi  1 , Fumio Suyama  1 , Shoichiro Amari  1 , Yushi Ito  1 , Yutaka Kanamori  2 , Hiroomi Okuyama  3 , Noriaki Usui  4 , Jun Sasahara  5 , Tomomi Kotani  6 , Masahiro Hayakawa  7 , Kiyoko Kato  8 , Tomoaki Taguchi  9 , Masayuki Endo  10 , Haruhiko Sago  1
Affiliations

Feasibility and outcomes of fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: A Japanese experience

Seiji Wada et al. J Obstet Gynaecol Res. 2020 Dec.

Abstract

Aim: To present the feasibility, safety and outcomes of fetoscopic endoluminal tracheal occlusion (FETO) for the treatment of severe congenital diaphragmatic hernia (CDH).

Methods: This was a single-arm clinical trial of FETO for isolated left-sided CDH with liver herniation and Kitano Grade 3 stomach position (>50% stomach herniation into the right chest). FETO was performed at 27-29 weeks of gestation for cases with observed/expected lung to head ratio (o/e LHR) <25% and at 30-31 weeks for cases with o/e LHR ≥25%.

Results: Eleven cases were enrolled between March 2014 and March 2016, and balloon insertion was successful in all cases. The median o/e LHR at entry was 27% (range, 20-33%). The median gestational age at FETO was 30.9 (range, 27.1-31.7) weeks. There were no severe maternal adverse events. One fetus died unexpectedly at 33 weeks of gestation due to cord strangulation by the detached amniotic membrane. There were 3 cases (27%) of preterm premature rupture of membranes. In all 10 cases, balloon removal at 34-35 weeks of gestation was successful. The median gestational age at delivery was 36.5 (range, 34.2-38.3) weeks. The median duration of occlusion and the median interval between balloon insertion and delivery were 26 days (range: 17-49 days) and 43 days (range, 21-66 days), respectively. Both the survival rate at 90 days of age and the rate of survival to discharge were 45% (5/11).

Conclusion: The FETO is feasible without maternal morbidity in Japan and could be offered to women whose fetuses show severe isolated left-sided CDH to accelerate fetal lung growth.

Keywords: adverse events; congenital diaphragmatic hernia; fetal mortality; fetal therapy; fetoscopy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A macroscopic view of the placenta in a case of fetal death (case 6). The arrow indicates cord strangulation by the detached amniotic membrane.
See this image and copyright information in PMC

References

    1. Gallot D, Boda C, Ughetto S et al Prenatal detection and outcome of congenital diaphragmatic hernia: A French registry‐based study. Ultrasound Obstet Gynecol 2007; 29: 276–283. - PubMed
    1. Gallot D, Coste K, Francannet C et al Antenatal detection and impact on outcome of congenital diaphragmatic hernia: A 12‐year experience in Auvergne, France. Eur J Obstet Gynecol Reprod Biol 2006; 125: 202–205. - PubMed
    1. Bagolan P, Casaccia G, Crescenzi F, Nahom A, Trucchi A, Giorlandino C. Impact of a current treatment protocol on outcome of high‐risk congenital diaphragmatic hernia. J Pediatr Surg 2004; 39: 313–318 discussion −8. - PubMed
    1. Masumoto K, Teshiba R, Esumi G et al Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization. Pediatr Surg Int 2009; 25: 487–492. - PubMed
    1. Okuyama H, Kitano Y, Saito M et al The Japanese experience with prenatally diagnosed congenital diaphragmatic hernia based on a multi‐institutional review. Pediatr Surg Int 2011; 27: 373–378. - PubMed