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Research: Fetal endoscopic tracheal occlusion and pulmonary hypertension in moderate congenital diaphragmatic hernia

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Research: Fetal endoscopic tracheal occlusion and pulmonary hypertension in moderate congenital diaphragmatic hernia

J Matern Fetal Neonatal Med

. 2021 Jun 6;1-6. doi: 10.1080/14767058.2021.1932806. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/34096456/

Fetal endoscopic tracheal occlusion and pulmonary hypertension in moderate congenital diaphragmatic hernia

Roopali Donepudi 1 2Michael A Belfort 1 2 3Alireza A Shamshirsaz 1 2Timothy C Lee 1 3Sundeep G Keswani 1 3Alice King 1 3Nancy A Ayres 1 4Caraciolo J Fernandes 1 5Magdalena Sanz-Cortes 1 2Ahmed A Nassr 1 2Andres F Espinoza 1 3Candace C Style 1 3Jimmy Espinoza 1 2Affiliations expand

Abstract

Objective: To study the role of fetal endoscopic tracheal occlusion (FETO) on resolution of pulmonary hypertension (PH) in fetuses with isolated moderate left-sided diaphragmatic hernia (CDH).

Methods: This retrospective study included fetuses with CDH evaluated between February 2004 and July 2017. Using the tracheal occlusion to accelerate lung growth (TOTAL) trial definition, we classified fetuses into moderate left CDH if O/E-LHR (observed/expected-lung head ratio) was 25-34.9% regardless of liver position or O/E-LHR of 35-44.9% if liver was in the chest. Postnatal echocardiograms were used to diagnose PH. Logistic regression analyses were performed to determine the relationship of FETO with study outcomes.

Results: Of 184 cases with no other major anomalies, 30 (16%) met criteria. There were nine FETO and 21 non-FETO cases. By hospital discharge, a higher proportion of infants in the FETO group had resolution of PH (87.5 (7/8) vs. 40% (8/20); p=.013). FETO was associated with adjusted odds ratio of 17.3 (95% CI: 1.75-171; p=.015) to resolve PH by hospital discharge. No significant differences were noted in need for ECMO or survival to discharge between groups.

Conclusions: Infants with moderate left-sided CDH according to O/E-LHR, FETO is associated with resolution of PH by the time of hospital discharge.

Keywords: Pulmonary hypertension; congenital diaphragmatic hernia; fetal survival; fetal tracheal occlusion; moderate severity CDH.

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