title: Rapidly polymerizing hydrogel prevents balloon dislodgement in a model of fetal tracheal occlusion.
abstract: OBJECTIVE
  This study examined whether an injectable hydrogel could buttress the balloon used in fetal tracheal occlusion, thus preventing its displacement.
  
  
  METHODS
  Fetal lambs (n = 11) underwent tracheal occlusion through local delivery of a detachable silicone balloon and were divided in 2 groups: group I had no further manipulations, and group II received an intratracheal injection of a rapidly polymerizing hydrogel, cranially to the balloon. Near term, balloon placement was examined, the lung volume-to-body weight ratio (LV:BW) was determined, and tracheal histology was performed. Statistical analysis was by the Fisher's Exact test, with significance set at P <.05.
  
  
  RESULTS
  Complete tracheal occlusion was achieved in all fetuses intraoperatively. The rate of balloon dislodgement was significantly higher in group I (4 of 7, or 57.1%) than in group II (0 of 4). In group II, balloons were recovered in situ with a column of residual hydrogel reinforcing their cephalad position. Animals in which balloon occlusion was maintained had significantly higher LV:BW, with no evidence of tracheal damage.
  
  
  CONCLUSIONS
  Intratracheal delivery of a rapidly polymerizing hydrogel cephalad to detachable silicone balloons results in improved fetal tracheal occlusion, with no harmful effects to the trachea. This adjuvant principle may enhance minimally invasive balloon tracheal occlusion for treatment of severe fetal pulmonary hypoplasia.
authors.affiliation: Department of Surgery, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Chang
authors.forename: Makoto
authors.initials: M
authors.lastname: Komura
authors.forename: Steven
authors.initials: S
authors.lastname: Andreoli
authors.forename: Russell
authors.initials: R
authors.lastname: Jennings
authors.forename: Jay
authors.initials: J
authors.lastname: Wilson
authors.forename: Dario
authors.initials: D
authors.lastname: Fauza
mesh_terms: D020341:Absorbable Implants; D000818:Animals; D002404:Catheterization; D000013:Congenital Abnormalities / Q000517:prevention & control; D004868:Equipment Failure; D005260:Female; D005315:Fetal Diseases / Q000628:therapy*; D006548:Hernia, Diaphragmatic / Q000196:embryology / Q000628:therapy*; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate / Q000737:chemistry / Q000627:therapeutic use*; D020883:Hysterotomy; D008168:Lung / Q000002:abnormalities / Q000196:embryology; D007752:Obstetric Labor, Premature / Q000209:etiology / Q000517:prevention & control; D011108:Polymers; D011247:Pregnancy; D012756:Sheep / Q000196:embryology; D014132:Trachea / Q000196:embryology
chemical_list: D011108:Polymers; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate