title: Fetoscopic Endoluminal Tracheal Occlusion in Fetuses with Severe Diaphragmatic Hernia: A Three-Year Single-Center Experience.
abstract: OBJECTIVE
  To report on our experience in the prenatal treatment of severe congenital diaphragmatic hernia (CDH) by fetoscopic endoluminal tracheal occlusion (FETO).
  
  
  METHODS
  Between 2012 and 2014, FETO was performed at our center in 21 cases of CDH considered to be severe based on sonographic measurement of observed/expected lung-to-head ratio (O/E LHR) and side of the defect. We reported pre- and postoperative ultrasound findings, procedure-related complications, pregnancy outcome and survival at 1-3 years of age.
  
  
  RESULTS
  The median gestational age (GA) at balloon insertion was 28.1 weeks (range 26.0-31.1) and the median GA at delivery 34.7 weeks (range 31.6-39.0); delivery before 32 and 34 weeks occurred in 2 (9.5%) and 7 (33.3%) cases, respectively. Postnatal survival at 1-3 years of age in the 17 cases with isolated unilateral CDH was 47.1%. The percentage difference between pre-balloon removal O/E LHR and pre-FETO O/E LHR was significantly higher in survivors compared to neonates who died (40.8 vs. 21.2%, respectively; p < 0.05).
  
  
  CONCLUSIONS
  In this study, FETO was associated with an infant survival of 47% in cases with isolated unilateral severe CDH. The post-FETO increase in O/E LHR was higher in fetuses that survived compared to those who died.
authors.affiliation: Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Persico
authors.forename: Isabella
authors.initials: I
authors.lastname: Fabietti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ciralli
authors.forename: Valerio
authors.initials: V
authors.lastname: Gentilino
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Ambrosi
authors.forename: Simona
authors.initials: S
authors.lastname: Boito
authors.forename: Manuela Wally
authors.initials: MW
authors.lastname: Ossola
authors.forename: Mariarosa
authors.initials: M
authors.lastname: Colnaghi
authors.forename: Valentina
authors.initials: V
authors.lastname: Condò
authors.forename: Francesco
authors.initials: F
authors.lastname: Macchini
authors.forename: Ernesto
authors.initials: E
authors.lastname: Leva
authors.forename: Fabio
authors.initials: F
authors.lastname: Mosca
authors.forename: Luigi
authors.initials: L
authors.lastname: Fedele
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005332:Fetoscopy / Q000379:methods*; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014132:Trachea / Q000000981:diagnostic imaging* / Q000601:surgery; D016216:Ultrasonography, Prenatal / Q000379:methods
keywords: Congenital diaphragmatic hernia; Fetal surgery; Fetal ultrasound; Fetoscopy; Lung hypoplasia; Tracheal occlusion