Prognostic value of pulmonary Doppler to predict response to tracheal occlusion in fetuses with congenital diaphragmatic hernia.
Pulmonary Doppler may play an important role in the prediction of survival and postnatal morbidity in fetuses with congenital diaphragmatic hernia treated with fetoscopic tracheal occlusion (FETO). Spectral Doppler indexes such as pulsatility index and peak early diastolic reversed flow could help to refine the selection of fetuses that might benefit from fetal therapy. When combined with lung-to-head ratio (LHR), these Doppler indices allow to discriminate cases with moderate-to-high survival rates from fetuses with extremely low chances to survive after FETO. In addition, they discriminate groups with a high or low risk of serious neonatal morbidity in surviving fetuses. After therapy, the combined evaluation of the relative increase of LHR with the increase in lung tissue perfusion by power Doppler seems to improve the prediction of fetal survival. In conclusion, while LHR remains the strongest predictive index, Doppler measurements allow to substantially improve the accuracy in the prediction of the chances of survival of fetuses with congenital diaphragmatic hernia treated with FETO.
Cruz-Martinez
Rogelio
R
Department of Maternal-Fetal Medicine, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic-IDIBAPS, University of Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain. egratacos @ clinic.ub.es
Hernandez-Andrade
Edgar
E
Moreno-Alvarez
Oscar
O
Done
Elisa
E
Deprest
Jan
J
Gratacos
Eduard
E
D047109:Fetal Development; D005332:Fetoscopy / Q000379:methods*; D005333:Fetus / Q000601:surgery*; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000196:embryology; D010477:Perfusion; D011379:Prognosis; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal