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

Roopali Donepudi, Michael A. Belfort, Alireza A. Shamshirsaz, Timothy C. Lee, Sundeep G. Keswani, Alice King, Nancy A. Ayres, Caraciolo J. Fernandes, Magdalena Sanz-Cortes, Ahmed A. Nassr, Andres F. Espinoza, Candace C. Style, Jimmy Espinoza
Baylor College of Medicine.
United States

Journal of Maternal Fetal and Neonatal Medicine
J Mat Fetal Neonat Med 2022; 35: 6967-6972
DOI: 10.1080/14767058.2021.1932806

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.

Category
Class III. Pulmonary Hypertension Associated with Lung Hypoplasia
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease

Age Focus: Pediatric Pulmonary Vascular Disease

Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication

Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: No

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