Correction of congenital diaphragmatic hernia in utero IX: Fetuses with poor prognosis (Liver herniation and low lung-to-head ratio) can be saved by fetoscopic temporary tracheal occlusion

摘要: Abstract Background/Purpose: Fetuses with congenital diaphragmatic hernia (CDH) who have a "poor prognosis" postnatal treatment now can be identified on the basis of liver herniation, early diagnosis (before 25 weeks' gestation) and low lung-to-head ratio (LHR). Because complete in utero repair proved unsuccessful for this group, strategy temporary tracheal occlusion was developed to gradually enlarge hypoplastic fetal lung. The purpose study is compare outcome patients poor-prognosis group treated by one three methods: (1) standard care, (2) via open hysterotomy, (3) recently video-fetoscopic (Fetendo) technique without hysterotomy. Methods: In past 3 years, 34 86 fetuses an isolated left CDH met criteria group. Thirteen families chose at extracorporeal membrane oxygenation (ECMO) center, 13 underwent occlusion, eight fetoscopic occlusion. Results: survival rate 38% therapy, 15% 75% Fetendo There were less postoperative pulmonary complications noted mothers procedure versus All but clip patient had striking physiological response demonstrated sonographic enlargement small lung that documented postnatally plain radiographs its subjective appearance during CDH. contrast, only 5 growth. Conclusion: herniation LHR are high risk neonatal demise appear benefit from when performed fetoscopically, not surgery.