Konjenital Diafragmatik Herni Tedavisinde Prenatal Dönemde Uygulanan Fetal Endoskopik Trakeal Oklüzyon İşleminin Etkinliği

2021 ◽  
Vol 6 (13) ◽  
pp. 31-37
Author(s):  
Barış SEVER ◽  
İbrahim ÖMEROĞLU ◽  
Hakan GÖLBAŞI ◽  
Duygu Adıyaman ◽  
Zübeyde ÇAKIR ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Lung Tissue ◽  
Diaphragmatic Hernia ◽  
Lung Development ◽  
Treatment Options ◽  
Postnatal Period ◽  
Left Ventricular ◽  
Response To Treatment ◽  
Prenatal Period ◽  
Tracheal Occlusion

Congenital diaphragmatic hernia is one of the rare malformations (0.8-5 / 10000). Although there are many treatment options in the postnatal period, as the severity of the malformation increases, the response to treatment decreases. Lung development is restricted by the compression of intraabdominal organs passing through the diaphragmatic defect. The severity of pulmonary hypertension due to hypoplasia in the lung tissue is closely related to postnatal morbidity and mortality. In addition to the lung tissue, left ventricular hypoplasia may also occur due to pressure on the heart. For all these reasons, treatment options have begun to be investigated even in the prenatal period, before tissue hypoplasia develops. In the last 20 years, there have been serious developments in ultrasound and magnetic resonance devices in parallel with the developments in technology. Accordingly, lung development of fetuses with diaphragmatic hernia during prenatal period has been better followed. Fetal endoscopic tracheal occlusion is the only method that can give treatment options to patients who are found to have severely decreased lung tissue in the prenatal period, in order to increase postpartum life expectancy. With this procedure, it is aimed to collect the fluids released from the lung with a balloon placed in the trachea in the prenatal period. Because of these accumulated fluids, the lung volume expands, tissue hypoplasia decreases, and the degree of pulmonary hypertension decreases. Although the fetal tracheal occlusion procedure has improved neonatal outcomes, there is a possibility of complications depending on the way the procedure is applied. Various complications such as premature rupture of membranes and preterm labor can be seen depending on the procedure. For this reason, it is necessary to choose the candidates for the tracheal occlusion procedure well and to calculate the profit-loss ratio well. In this study, current publications of fetal endoscopic tracheal occlusion procedure were reviewed. It was investigated on which patients the procedure could be applied and what the benefits and harms might be if it was applied.

scholarly journals Left ventricular cardiac function in fetuses with congenital diaphragmatic hernia and the effect of fetal endoscopic tracheal occlusion

2009 ◽  
Vol 34 (4) ◽  
pp. 424-429 ◽  
Author(s):  
T. Van Mieghem ◽  
L. Gucciardo ◽  
E. Doné ◽  
D. Van Schoubroeck ◽  
E. M. Graatsma ◽  
...  
Keyword(s):  
Cardiac Function ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Left Ventricular ◽  
Tracheal Occlusion

Complementary Effect of Maternal Sildenafil and Fetal Tracheal Occlusion Improves Lung Development in the Rabbit Model of Congenital Diaphragmatic Hernia

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Francesca Maria Russo ◽  
Marina Gabriela Monteiro Carvalho Mori Da Cunha ◽  
Julio Jimenez ◽  
Flore Lesage ◽  
Mary Patrice Eastwood ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Lung Development ◽  
Rabbit Model ◽  
Tracheal Occlusion ◽  
Complementary Effect

scholarly journals Non-invasive imaging of global and regional cardiac function in pulmonary hypertension

2017 ◽  
Vol 8 (1) ◽  
pp. 204589321774200 ◽  
Author(s):  
Tim Crowe ◽  
Geeshath Jayasekera ◽  
Andrew J. Peacock
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Function ◽  
Left Ventricular ◽  
Cardiac Response ◽  
Response To Treatment ◽  
Advantages And Disadvantages ◽  
Non Invasive ◽  
Pulmonary Hemodynamic ◽  
Regional Cardiac Function ◽  
Rv Function

Pulmonary hypertension (PH) is a progressive illness characterized by elevated pulmonary artery pressure; however, the main cause of mortality in PH patients is right ventricular (RV) failure. Historically, improving the hemodynamics of pulmonary circulation was the focus of treatment; however, it is now evident that cardiac response to a given level of pulmonary hemodynamic overload is variable but plays an important role in the subsequent prognosis. Non-invasive tests of RV function to determine prognosis and response to treatment in patients with PH is essential. Although the right ventricle is the focus of attention, it is clear that cardiac interaction can cause left ventricular dysfunction, thus biventricular assessment is paramount. There is also focus on the atrial chambers in their contribution to cardiac function in PH. Furthermore, there is evidence of regional dysfunction of the two ventricles in PH, so it would be useful to understand both global and regional components of dysfunction. In order to understand global and regional cardiac function in PH, the most obvious non-invasive imaging techniques are echocardiography and cardiac magnetic resonance imaging (CMRI). Both techniques have their advantages and disadvantages. Echocardiography is widely available, relatively inexpensive, provides information regarding RV function, and can be used to estimate RV pressures. CMRI, although expensive and less accessible, is the gold standard of biventricular functional measurements. The advent of 3D echocardiography and techniques including strain analysis and stress echocardiography have improved the usefulness of echocardiography while new CMRI technology allows the measurement of strain and measuring cardiac function during stress including exercise. In this review, we have analyzed the advantages and disadvantages of the two techniques and discuss pre-existing and novel forms of analysis where echocardiography and CMRI can be used to examine atrial, ventricular, and interventricular function in patients with PH at rest and under stress.

scholarly journals Increased TGF-β: a drawback of tracheal occlusion in human and experimental congenital diaphragmatic hernia?

2016 ◽  
Vol 310 (4) ◽  
pp. L311-L327 ◽  
Author(s):  
Aline Vuckovic ◽  
Susanne Herber-Jonat ◽  
Andreas W. Flemmer ◽  
Ina M. Ruehl ◽  
Carmela Votino ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Congenital Diaphragmatic Hernia ◽  
Lung Tissue ◽  
Diaphragmatic Hernia ◽  
Tissue Mechanics ◽  
Sham Operation ◽  
Lung Growth ◽  
Tracheal Occlusion ◽  
Matrix Deposition ◽  
Extracellular Matrix Components

Survivors of severe congenital diaphragmatic hernia (CDH) present significant respiratory morbidity despite lung growth induced by fetal tracheal occlusion (TO). We hypothesized that the underlying mechanisms would involve changes in lung extracellular matrix and dysregulated transforming growth factor (TGF)-β pathway, a key player in lung development and repair. Pulmonary expression of TGF-β signaling components, downstream effectors, and extracellular matrix targets were evaluated in CDH neonates who died between birth and the first few weeks of life after prenatal conservative management or TO, and in rabbit pups that were prenatally randomized for surgical CDH and TO vs. sham operation. Before tissue harvesting, lung tissue mechanics in rabbits was measured using the constant-phase model during the first 30 min of life. Human CDH and control fetal lungs were also collected from midterm onwards. Human and experimental CDH did not affect TGF-β/Smad2/3 expression and activity. In human and rabbit CDH lungs, TO upregulated TGF-β transcripts. Analysis of downstream pathways indicated increased Rho-associated kinases to the detriment of Smad2/3 activation. After TO, subtle accumulation of collagen and α-smooth muscle actin within alveolar walls was detected in rabbit pups and human CDH lungs with short-term mechanical ventilation. Despite TO-induced lung growth, mediocre lung tissue mechanics in the rabbit model was associated with increased transcription of extracellular matrix components. These results suggest that prenatal TO increases TGF-β/Rho kinase pathway, myofibroblast differentiation, and matrix deposition in neonatal rabbit and human CDH lungs. Whether this might influence postnatal development of sustainably ventilated lungs remains to be determined.

scholarly journals Fetal endoscopic tracheal occlusion reduces pulmonary hypertension in severe congenital diaphragmatic hernia

2019 ◽  
Vol 54 (6) ◽  
pp. 752-758 ◽  
Author(s):  
C. C. Style ◽  
O. O. Olutoye ◽  
M. A. Belfort ◽  
N. A. Ayres ◽  
S. M. Cruz ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Tracheal Occlusion
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