How should fetal surgery for congenital diaphragmatic hernia be implemented in the post‐TOTAL trial era: a discussion #

2022 ◽  
Author(s):  
Jan Deprest ◽  
Alan Flake
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Fetal Surgery ◽  
Total Trial

Right-sided congenital diaphragmatic hernia in a decade of fetal surgery

2014 ◽  
Vol 122 (7) ◽  
pp. 940-946 ◽  
Author(s):  
P DeKoninck ◽  
O Gomez ◽  
I Sandaite ◽  
J Richter ◽  
K Nawapun ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Fetal Surgery

scholarly journals Fetoscopic abdominal decompression of congenital diaphragmatic hernia – preliminary results of a fetal sheep model

2014 ◽  
Author(s):  
Felipe Fromm ◽  
Katharina Wenke ◽  
Thomas Krebs ◽  
Michael Boettcher ◽  
Georg Eschenburg ◽  
...  
Keyword(s):  
Animal Model ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Fetal Surgery ◽  
Amniotic Cavity ◽  
Sheep Model ◽  
Fetal Sheep ◽  
Tracheal Occlusion ◽  
Animal Trials ◽  
Abdominal Decompression

Background Severe congenital diaphragmatic hernia (CDH) is prenatally managed by fetoscopic tracheal occlusion (FETO) to improve lung growth and maturation. As FETO is not able to reduce the pressure onto the developing lungs originating from the intestine growing into the thoracic cavity, fetal abdominal decompression may alleviate this pressure effect by directing the growing intestine into the amniotic cavity away from the lungs. Therefore, aim of this study was to establish an animal model for fetoscopic abdominal decompression in fetal sheep with CDH. Methods CDH was created surgically on day 75 of 145 day gestation in eight fetuses. 2-3 weeks later, an opening was created in the fetal abdomen by fetoscopic surgery. The fetuses were retrieved by cesarean section at the end of pregnancy and evaluated. Results Five fetuses with CDH were treated with fetoscopic abdominal decompression. Three fetuses with CDH were taken as controls. One fetus was lost after creation of the CDH and two other after creation of the abdominal defect. Preliminary sterological results showed that the septal thickness of the experimental group was smaller than in the CDH group. Conclusion This study demonstrates the general feasibility of fetoscopic abdominal decompression for diaphragmatic hernia in our new animal model. Although not statistically significant, the lungs of treated fetuses were larger and heavier than those of untreated controls. Our findings support the hypothesis of palliative fetal surgery for severe CDH compared to tracheal occlusion. More controlled animal trials are needed.

scholarly journals Outcome of fetuses with congenital diaphragmatic hernia and associated intrafetal fluid effusions managed in the era of fetal surgery

2011 ◽  
Vol 39 (1) ◽  
pp. 50-55 ◽  
Author(s):  
T. Van Mieghem ◽  
R. Cruz-Martinez ◽  
K. Allegaert ◽  
P. Dekoninck ◽  
M. Castanon ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Fetal Surgery

scholarly journals Perinatal stabilisation of infants born with congenital diaphragmatic hernia: a review of current concepts

2020 ◽  
Vol 105 (4) ◽  
pp. 449-454
Author(s):  
Emily J J Horn-Oudshoorn ◽  
Ronny Knol ◽  
Arjan B Te Pas ◽  
Stuart B Hooper ◽  
Suzan C M Cochius-den Otter ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Management Strategies ◽  
Fetal Surgery ◽  
Adverse Outcomes ◽  
Delivery Room ◽  
Treatment Modalities ◽  
Mortality And Morbidity ◽  
Early Predictors ◽  
Stabilisation Period

Congenital diaphragmatic hernia (CDH) is associated with high mortality rates and significant pulmonary morbidity, mainly due to disrupted lung development related to herniation of abdominal organs into the chest. Pulmonary hypertension is a major contributor to both mortality and morbidity, however, treatment modalities are limited. Novel prenatal and postnatal interventions, such as fetal surgery and medical treatments, are currently under investigation. Until now, the perinatal stabilisation period immediately after birth has been relatively overlooked, although optimising support in these early stages may be vital in improving outcomes. Moreover, physiological parameters obtained from the perinatal stabilisation period could serve as early predictors of adverse outcomes, thereby facilitating both prevention and early treatment of these conditions. In this review, we focus on the perinatal stabilisation period by discussing the current delivery room guidelines in infants born with CDH, the physiological changes occurring during the fetal-to-neonatal transition in CDH, novel delivery room strategies and early predictors of adverse outcomes. The combination of improvements in the perinatal stabilisation period and early prediction of adverse outcomes may mitigate the need for specific postnatal management strategies.

Left-sided congenital diaphragmatic hernia: value of prenatal MR imaging in preparation for fetal surgery.

Radiology ◽  
1997 ◽  
Vol 203 (3) ◽  
pp. 636-640 ◽  
Author(s):  
A M Hubbard ◽  
N S Adzick ◽  
T M Crombleholme ◽  
J C Haselgrove
Keyword(s):  
Mr Imaging ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Fetal Surgery
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