Early fetoscopic tracheal occlusion for extremely severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: Preliminary results

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dc.contributor.authorRuano, Rodrigo
dc.contributor.authorPeiro, Jose Luis
dc.contributor.authorSilva, Marcos Marques da
dc.contributor.authorCampos, Juliana Alvares Duarte Bonini [UNESP]
dc.contributor.authorCarreras, Elena
dc.contributor.authorTannuri, Uenis
dc.contributor.authorZugaib, Marcelo
dc.contributor.institutionUniversidade de São Paulo (USP)
dc.contributor.institutionTexas Children's Hospital
dc.contributor.institutionHospital Universitari Vall d'Hebron
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.date.accessioned2014-05-27T11:29:48Z
dc.date.available2014-05-27T11:29:48Z
dc.date.issued2013-07-01
dc.description.abstractObjective: To evaluate the effect of early fetoscopictracheal occlusion (FETO) (22–24 weeks’ gestation) onpulmonary response and neonatal survival in cases ofextremely severe isolated congenital diaphragmatic hernia(CDH). Methods: This was a multicenter study involving fetuseswith extremely severe CDH (lung-to-head ratio < 0.70,liver herniation into the thoracic cavity and no otherdetectable anomalies). Between August 2010 and December 2011, eight fetuses underwent early FETO. Datawere compared with nine fetuses that underwent standard FETO and 10 without fetoscopic procedure fromJanuary 2006 to July 2010. FETO was performed undermaternal epidural anesthesia, supplemented with fetalintramuscular anesthesia. Fetal lung size and vascularitywere evaluated by ultrasound before and every 2 weeksafter FETO. Postnatal therapy was equivalent for bothtreated fetuses and controls. Primary outcome was infantsurvival to 180 days and secondary outcome was fetalpulmonary response. Results: Maternal and fetal demographic characteristicsand obstetric complications were similar in the threegroups (P > 0.05). Infant survival rate was significantlyhigher in the early FETO group (62.5%) comparedwith the standard group (11.1%) and with controls(0%) (P < 0.01). Early FETO resulted in a significantimprovement in fetal lung size and pulmonary vascularitywhen compared with standard FETO (P < 0.01). Conclusions: Early FETO may improve infant survival byfurther increases of lung size and pulmonary vascularityin cases with extremely severe pulmonary hypoplasia inisolated CDH. This study supports formal testing of thehypothesis with a randomized controlled trial.en
dc.description.affiliationObstetrics Department Faculdade de Medicina Universidade de São Paulo, Rua Valentim Magalhães, 100, ap 52, São Paulo, SP, 03184-090
dc.description.affiliationDepartment of Obstetrics and Gynecology Baylor College of Medicine Texas Children's Hospital, Houston, TX
dc.description.affiliationFetal Surgery Program Hospital Universitari Vall d'Hebron, Barcelona
dc.description.affiliationPediatric Surgery Faculdade de Medicina Universidade de São Paulo, São Paulo
dc.description.affiliationSocial Department Faculdade de Odontologia Universidade Estadual Paulista, Araraquara
dc.description.affiliationUnespUniversidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Odontologia Social, Faculdade de Odontologia de Araraquara
dc.format.extent70-76
dc.identifierhttp://onlinelibrary.wiley.com/doi/10.1002/uog.12414/abstract
dc.identifier.citationUltrasound in Obstetrics and Gynecology, v. 42, n. 1, p. 70-76, 2013.
dc.identifier.doi10.1002/uog.12414
dc.identifier.issn0960-7692
dc.identifier.issn1469-0705
dc.identifier.lattes7167211040669505
dc.identifier.scopus2-s2.0-84879493434
dc.identifier.urihttp://hdl.handle.net/11449/130414
dc.identifier.wosWOS:000320778500011
dc.language.isoeng
dc.relation.ispartofUltrasound in Obstetrics & Gynecology
dc.relation.ispartofjcr5.654
dc.relation.ispartofsjr2,647
dc.relation.ispartofsjr2,647
dc.rights.accessRightsAcesso restrito
dc.sourceScopus
dc.subject3D power Doppleren
dc.subjectCongenital diaphragmatic herniaen
dc.subjectFetal surgeryen
dc.subjectFetal tracheal occlusionen
dc.subjectFetoscopyen
dc.subjectPulmonary hypoplasiaen
dc.subjectThree-dimensional ultrasonographen
dc.titleEarly fetoscopic tracheal occlusion for extremely severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: Preliminary resultsen
dc.typeArtigo
dcterms.licensehttp://olabout.wiley.com/WileyCDA/Section/id-406071.html
unesp.author.lattes7167211040669505
unesp.campusUniversidade Estadual Paulista (Unesp), Faculdade de Odontologia, Araraquarapt
unesp.departmentOdontologia Socialpt

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