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. 2026 Jan;47(1):132-140.
doi: 10.1007/s00246-024-03735-y. Epub 2024 Dec 13.

Echocardiographic Changes in Infants with Severe Congenital Diaphragmatic Hernia After Fetoscopic Endoluminal Tracheal Occlusion (FETO)

Catherine M Avitabile  1   2 , Sabrina Flohr  3 , Leny Mathew  3 , Yan Wang  4 , Devon Ash  4 , Juliana S Gebb  5 , Natalie E Rintoul  6   7 , Holly L Hedrick  3
Affiliations

Echocardiographic Changes in Infants with Severe Congenital Diaphragmatic Hernia After Fetoscopic Endoluminal Tracheal Occlusion (FETO)

Catherine M Avitabile et al. Pediatr Cardiol. 2026 Jan.

Abstract

Fetoscopic endoluminal tracheal occlusion (FETO) induces lung growth and may improve survival in congenital diaphragmatic hernia (CDH) but the effect on post-natal right (RV) and left (LV) ventricular size and cardiac function is unknown. Quantitative measures of heart size and function including tricuspid annular plane systolic excursion Z-score (TAPSEZ), RV fractional area change (RVFAC), RV global longitudinal and free wall strain (RVGLS, RVFWS), RV/LV ratio, LV eccentricity index (LVEI), and LV M-mode diastolic and systolic Z-scores (LVIDDZ, LVIDSZ) were compared between FETO and control patients on first post-natal echocardiogram, prior to and post CDH repair, and on last available echocardiogram using non-parametric Wilcoxon rank-sum test in a single-center, retrospective cohort study. Linear regression models evaluated change over time, adjusting for clustering and interaction of echocardiogram parameters with time. Thirty-two patients (10 FETO, 22 control) met inclusion criteria. At first echocardiogram, FETO patients demonstrated lower RV/LV ratio and LVEI (p = 0.01 for both) indicating less RV dilation and less ventricular septal displacement, respectively. LV hypoplasia was less severe in FETO patients (p = 0.01 for both LVIDDZ and LVIDSZ) initially. After repair, FETO patients demonstrated better RV systolic function compared to control patients by FAC (p < 0.01), RVGLS (p = 0.02), and RVFWS (p = 0.05). Over time, FETO patients demonstrated greater improvements in RV/LV ratio and LVEI but smaller increases in LV dimensions compared to control patients. Improvements in RV function were similar between the groups. FETO patients demonstrate differences in cardiac size and function compared to control patients.

Keywords: Congenital diaphragmatic hernia; Echocardiogram; Pulmonary hypertension; Strain.

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Conflict of interest statement

Declarations. Competing Interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Measurement of LVEI and RV/LV ratio. End-systolic LVEI is measured as the ratio of the LV dimension parallel to the ventricular septum (pink) to the LV dimension perpendicular to the ventricular septum (blue) in parasternal short axis view. Systolic RV/LV ratio is measured as the ratio of the RV dimension (green) to the LV dimension perpendicular to the ventricular septum (blue) in the parasternal short axis view
Fig. 2
Fig. 2
Changes in LV Z-scores for FETO and control patients. At last available echocardiogram, the increases in LVIDDZ and LVIDSZ were on average 2.22 and 2.75 units smaller, respectively, in the FETO patients than the control patients
Fig. 3
Fig. 3
Changes in RV/LV ratio and LVEI for FETO and control patients. RV/LV ratio and LVEI decreased over time from first to last echocardiogram, and the decrease was greater in the FETO group on average
See this image and copyright information in PMC

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