| 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. | |
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MedLine Citation:
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PMID: 9694087 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND/PURPOSE: Fetuses with congenital diaphragmatic hernia (CDH) who have a "poor prognosis" with postnatal treatment now can be identified on the basis of liver herniation, early diagnosis (before 25 weeks' gestation) and a low lung-to-head ratio (LHR). Because complete in utero repair proved unsuccessful for this group, the strategy of temporary tracheal occlusion was developed to gradually enlarge the hypoplastic fetal lung. The purpose of this study is to compare the outcome of patients in the poor-prognosis group treated by one of three methods: (1) standard postnatal care, (2) fetal tracheal occlusion via open hysterotomy, and (3) the recently developed video-fetoscopic (Fetendo) technique of tracheal occlusion without hysterotomy. METHODS: In the past 3 years, 34 of 86 fetuses with an isolated left CDH met criteria for the poor-prognosis group. Thirteen families chose postnatal treatment at an extracorporeal membrane oxygenation (ECMO) center, 13 underwent open fetal tracheal occlusion, and eight underwent fetoscopic tracheal occlusion. RESULTS: The survival rate was 38% in the group treated by standard postnatal therapy, 15% in the open tracheal occlusion group, and 75% in the Fetendo group. There were less postoperative pulmonary complications noted in mothers who underwent the Fetendo procedure versus the open tracheal occlusion. All but one Fetendo clip patient had a striking physiological response demonstrated by sonographic enlargement of the small left lung that was documented postnatally by plain radiographs and its subjective appearance during repair of the CDH. In contrast, only 5 of the 13 open tracheal occlusion patients demonstrated lung growth. CONCLUSION: Fetuses with a left CDH who have liver herniation and a low LHR are at high risk of neonatal demise and appear to benefit from temporary tracheal occlusion when performed fetoscopically, but not when performed by open fetal surgery. |
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Authors:
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M R Harrison; G B Mychaliska; C T Albanese; R W Jennings; J A Farrell; S Hawgood; P Sandberg; A H Levine; E Lobo; R A Filly |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of pediatric surgery Volume: 33 ISSN: 0022-3468 ISO Abbreviation: J. Pediatr. Surg. Publication Date: 1998 Jul |
Date Detail:
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Created Date: 1998-10-22 Completed Date: 1998-10-22 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 0052631 Medline TA: J Pediatr Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1017-22; discussion 1022-3 Citation Subset: IM |
Affiliation:
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The Fetal Treatment Center and the Department of Surgery, University of California, San Francisco 94143-0570, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Chi-Square Distribution Endoscopy Female Fetal Diseases / mortality, surgery* Fetal Organ Maturity Fetoscopy Hernia, Diaphragmatic / complications, congenital*, mortality, surgery* Humans Liver Diseases / complications Lung / embryology* Pregnancy Pregnancy, High-Risk Prognosis Prostheses and Implants Survival Rate Trachea* |
| Grant Support | |
ID/Acronym/Agency:
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T32 DK 07573/DK/NIDDK NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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