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Chapter 7 - Fetal Endoscopic Tracheal Occlusion (FETO)

from Section 2

Published online by Cambridge University Press:  19 November 2021

Olutoyin A. Olutoye
Affiliation:
Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois
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Summary

Despite advances in neonatal and surgical care, the outcome of severe congenital diaphragmatic hernia (CDH) is still quite poor. Improvements in the ability to diagnose and risk stratify CDH prenatally have led to investigations into whether the more severe forms of CDH may benefit from in-utero intervention to ameliorate the accompanying pulmonary hypoplasia. Fetal endoscopic tracheal occlusion (FETO) is an example of a prenatal surgical intervention that was made possible by the technological advancements in endoscopic surgery. FETO is generally performed in fetuses with more severe forms of CDH to stimulate prenatal lung growth. While FETO is still considered investigational therapy and has not attained standard of care status, the results from published data to date have been promising. The complexity of FETO, coupled with the surgical and anesthetic risk to the mother and fetus requires a highly functional multidisciplinary fetal team, which includes obstetrics, pediatric surgery, and anesthesiology. This chapter will provide an in-depth understanding of the history of fetal endoscopic tracheal occlusion for CDH, the operative and anesthetic approach to FETO and associated perioperative considerations. Congenital diaphragmatic hernia continues to be a disease that perplexes obstetricians, neonatologists, surgeons, anesthesiologists, and the entire care team.

Type
Chapter
Information
Anesthesia for Maternal-Fetal Surgery
Concepts and Clinical Practice
, pp. 95 - 102
Publisher: Cambridge University Press
Print publication year: 2021

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References

Verla, MA, Style, CC, Olutoye, OO. Prenatal intervention for the management of congenital diaphragmatic hernia. Pediatr Surg Int. 2018;34(6):579587.CrossRefGoogle ScholarPubMed
Allan, DW, Greer, JJ. Pathogenesis of nitrofen-induced congenital diaphragmatic hernia in fetal rats. J Appl Physiol. 1997;83(2):338347.Google Scholar
Butler, N, Claireaux, AE. Congenital diaphragmatic hernia as a cause of perinatal mortality. Lancet. 1962;1(7231):659663.Google Scholar
Harrison, MR, Adzick, NS, Estes, JM, Howell, LJ. A prospective study of the outcome for fetuses with diaphragmatic hernia. JAMA. 1994;271(5):382384.CrossRefGoogle ScholarPubMed
Mah, VK, Zamakhshary, M, Mah, DY, et al. Absolute vs relative improvements in congenital diaphragmatic hernia survival: what happened to “hidden mortality.” J Pediatr Surg. 2009;44(5):877882.Google Scholar
Mehollin-Ray, AR, Cassady, CI, Cass, DL, Olutoye, OO. Fetal MR imaging of congenital diaphragmatic hernia. Radiographics. 2012;32(4):10671084.CrossRefGoogle ScholarPubMed
Mesas Burgos, C, Hammarqvist-Vejde, J, Frenckner, B, Conner, P. Differences in outcomes in prenatally diagnosed congenital diaphragmatic hernia compared to postnatal detection: a single-center experience. Fetal Diagn Ther. 2016;39(4):241247.Google Scholar
Akinkuotu, AC, Cruz, SM, Abbas, PI, et al. Risk-stratification of severity for infants with CDH: Prenatal versus postnatal predictors of outcome. J Pediatr Surg. 2016;51(1):4448.CrossRefGoogle ScholarPubMed
Jani, J, Nicolaides, KH, Keller, RL, et al. Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet Gynecol. 2007;30(1):6771.CrossRefGoogle ScholarPubMed
Zamora, IJ, Olutoye, OO, Cass, DL, et al. Prenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH). J Pediatr Surg. 2014;49(5):688693.Google Scholar
Kohl, T. Minimally invasive fetoscopic interventions: an overview in 2010. Surg Endosc. 2010;24(8):20562067.Google Scholar
Ruano, R, Ali, RA, Patel, P, et al. Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: indications, outcomes, and future directions. Obstet Gynecol Surv. 2014;69(3):147158.CrossRefGoogle ScholarPubMed
Peiro, JL, Carreras, E, Guillen, G, et al. Therapeutic indications of fetoscopy: a 5-year institutional experience. J Laparoendosc Adv Surg Tech A. 2009;19(2):229236.CrossRefGoogle ScholarPubMed
Belfort, MA, Olutoye, OO, Cass, DL, et al. Feasibility and outcomes of fetoscopic tracheal occlusion for severe left diaphragmatic hernia. Obstet Gynecol. 2017;129(1):2029.Google Scholar
Deprest, J, Nicolaides, K, Done, E, et al. Technical aspects of fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia. J Pediatr Surg. 2011;46(1):2232.CrossRefGoogle ScholarPubMed
Kohl, T, Muller, A, Franz, A, et al. Temporary fetoscopic tracheal balloon occlusion enhanced by hyperoncotic lung distension: is there a role in the treatment of fetal pulmonary hypoplasia from early preterm premature rupture of membranes? Fetal Diagn Ther. 2007;22(6):462465.Google Scholar
Kohl, T, Geipel, A, Tchatcheva, K, et al. Life-saving effects of fetal tracheal occlusion on pulmonary hypoplasia from preterm premature rupture of membranes. Obstet Gynecol. 2009;113 (2 Pt 2):480483.Google Scholar
Lally, KP. Congenital diaphragmatic hernia – the past 25 (or so) years. J Pediatr Surg. 2016;51(5):695698.CrossRefGoogle ScholarPubMed
Harrison, MR, Adzick, NS, Bullard, KM, et al. Correction of congenital diaphragmatic hernia in utero VII: a prospective trial. J Pediatr Surg. 1997;32(11):16371642.Google Scholar
Harrison, MR, Adzick, NS, Longaker, MT, et al. Successful repair in utero of a fetal diaphragmatic hernia after removal of herniated viscera from the left thorax. N Engl J Med. 1990;322(22):15821584.Google Scholar
Harrison, MR, Adzick, NS, Flake, AW, Jennings, RW. The CDH two-step: a dance of necessity. J Pediatr Surg. 1993;28(6):813816.Google Scholar
Harrison, MR, Adzick, NS, Flake, AW, et al. Correction of congenital diaphragmatic hernia in utero: VI. Hard-earned lessons. J Pediatr Surg. 1993;28(10):1411–1417.Google Scholar
MacGillivray, TE, Jennings, RW, Rudolph, AM, et al. Vascular changes with in utero correction of diaphragmatic hernia. J Pediatr Surg. 1994;29(8):992996.CrossRefGoogle ScholarPubMed
Skarsgard, ED, Meuli, M, VanderWall, KJ, et al. Fetal endoscopic tracheal occlusion (‘Fetendo-PLUG’) for congenital diaphragmatic hernia. J Pediatr Surg. 1996;31(10):13351338.CrossRefGoogle ScholarPubMed
Alcorn, D, Adamson, TM, Lambert, TF, et al. Morphological effects of chronic tracheal ligation and drainage in the fetal lamb lung. J Anat. 1977;123(Pt 3):649660.Google Scholar
Carmel, JA, Friedman, F, Adams, FH. Fetal tracheal ligation and lung development. Am J Dis Child. 1965;109(5):452456.Google Scholar
Lanman, JT, Schaffer, A, Herod, L, et al. Distensibility of the fetal lung with fluid in sheep. Pediatr Res. 1971;5:586.CrossRefGoogle Scholar
Wilson, JM, DiFiore, JW, Peters, CA. Experimental fetal tracheal ligation prevents the pulmonary hypoplasia associated with fetal nephrectomy: possible application for congenital diaphragmatic hernia. J Pediatr Surg. 1993;28(11):1433–1439.CrossRefGoogle ScholarPubMed
Beierle, EA, Langham, MR, Jr., Cassin, S. In utero lung growth of fetal sheep with diaphragmatic hernia and tracheal stenosis. J Pediatr Surg. 1996;31(1):141146.Google Scholar
Bealer, JF, Skarsgard, ED, Hedrick, MH, et al. The ‘PLUG’ odyssey: adventures in experimental fetal tracheal occlusion. J Pediatr Surg. 1995;30(2):361364.Google Scholar
DiFiore, JW, Fauza, DO, Slavin, R, et al. Experimental fetal tracheal ligation reverses the structural and physiological effects of pulmonary hypoplasia in congenital diaphragmatic hernia. J Pediatr Surg. 1994;29(2):248256.CrossRefGoogle ScholarPubMed
Hedrick, MH, Estes, JM, Sullivan, KM, et al. Plug the lung until it grows (PLUG): a new method to treat congenital diaphragmatic hernia in utero. J Pediatr Surg. 1994;29(5):612617.Google Scholar
Harrison, MR, Adzick, NS, Flake, AW, et al. Correction of congenital diaphragmatic hernia in utero VIII: Response of the hypoplastic lung to tracheal occlusion. J Pediatr Surg. 1996;31(10):13391348.Google Scholar
Mychaliska, GB, Bealer, JF, Graf, JL, et al. Operating on placental support: the ex utero intrapartum treatment procedure. J Pediatr Surg. 1997;32(2):227230.Google Scholar
Harrison, MR, Albanese, CT, Hawgood, SB, et al. Fetoscopic temporary tracheal occlusion by means of detachable balloon for congenital diaphragmatic hernia. Am J Obstet Gynecol. 2001;185(3):730733.Google Scholar
Harrison, MR, Sydorak, RM, Farrell, JA, et al. Fetoscopic temporary tracheal occlusion for congenital diaphragmatic hernia: prelude to a randomized, controlled trial. J Pediatr Surg. 2003;38(7):10121020.Google Scholar
Chiba, T, Albanese, CT, Farmer, DL, et al. Balloon tracheal occlusion for congenital diaphragmatic hernia: experimental studies. J Pediatr Surg. 2000;35(11):15661570.Google Scholar
Longaker, MT, Golbus, MS, Filly, RA, et al. Maternal outcome after open fetal surgery. A review of the first 17 human cases. JAMA. 1991;265(6):737741.Google Scholar
Deprest, J, Gratacos, E, Nicolaides, KH. Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results. Ultrasound Obstet Gynecol. 2004;24(2):121126.Google Scholar
Luks, FI, Gilchrist, BF, Jackson, BT, Piasecki, GJ. Endoscopic tracheal obstruction with an expanding device in a fetal lamb model: preliminary considerations. Fetal Diagn Ther. 1996;11(1):6771.Google Scholar
Kohl, T. Fetoscopic surgery: where are we today? Curr Opin Anaesthesiol. 2004;17(4):315321.CrossRefGoogle ScholarPubMed
Ruano, R, Yoshisaki, CT, da Silva, MM, et al. A randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol. 2012;39(1):2027.Google Scholar
Deprest, J, Jani, J, Gratacos, E, et al. Fetal intervention for congenital diaphragmatic hernia: the European experience. Semin Perinatol. 2005;29(2):94103.Google Scholar
Jani, J, Gratacos, E, Greenough, A, et al. Percutaneous fetal endoscopic tracheal occlusion (FETO) for severe left-sided congenital diaphragmatic hernia. Clin Obstet Gynecol. 2005;48(4):910922.Google Scholar
Peralta, CF, Sbragia, L, Bennini, JR, et al. Fetoscopic endotracheal occlusion for severe isolated diaphragmatic hernia: initial experience from a single clinic in Brazil. Fetal Diagn Ther. 2011;29(1):7177.Google Scholar
Jani, JC, Nicolaides, KH, Gratacos, E, et al. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol. 2009;34(3):304310.Google Scholar

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