The impact of fetal endoscopic tracheal occlusion in isolated left-sided congenital diaphragmatic hernia on left-sided cardiac dimensions

Gurpreet S. Dhillon, Shiraz A. Maskatia, Robert W. Loar, John L. Colquitt, Amy R. Mehollin-Ray, Rodrigo Ruano, Michael A. Belfort, Oluyinka O. Olutoye, Joshua A. Kailin

Research output: Contribution to journalArticle

Abstract

Objectives: Fetal endoscopic tracheal occlusion (FETO) is offered to fetuses with congenital diaphragmatic hernia (CDH) and severe lung hypoplasia to promote lung growth and may secondarily affect left heart growth. The effects of FETO on left heart hypoplasia (LHH) are not described post-CDH repair. Methods: A retrospective analysis was performed for fetuses with left-sided CDH who underwent FETO and severity-matched controls from 2007 to 2016 at our institution. Echocardiographic, ultrasound, and MRI data were reviewed. Left heart dimensions were assessed prenatally and postnatally. Primary clinical outcome evaluated was death. Results: Twelve FETO patients and 18 controls were identified. Fetal LHH was noted in both groups and worsened after FETO. Postnatal mitral valve dimensions were larger in the FETO group pre-CDH repair (P =.03). Post-CDH repair, mitral valve and left ventricular dimensions were not significantly different between groups (P =.79 and P =.63 respectively) while FETO aortic valve dimensions were smaller (P =.04). Extracorporeal membrane oxygenation use was lower in the FETO group. No associations were found between left heart dimensions and outcomes. Conclusion: Although increased lung growth was seen after FETO, fetal LHH persisted with relative normalization seen post-repair. Persistent LHH post-FETO could be secondary to a small contribution of pulmonary venous return to the fetal left heart and increased intrathoracic pressures post-FETO.

Original languageEnglish (US)
JournalPrenatal Diagnosis
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Fetal Heart
Herniorrhaphy
Lung
Mitral Valve
Fetus
Growth
Extracorporeal Membrane Oxygenation
Aortic Valve
Congenital Diaphragmatic Hernias
Pressure

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Genetics(clinical)

Cite this

The impact of fetal endoscopic tracheal occlusion in isolated left-sided congenital diaphragmatic hernia on left-sided cardiac dimensions. / Dhillon, Gurpreet S.; Maskatia, Shiraz A.; Loar, Robert W.; Colquitt, John L.; Mehollin-Ray, Amy R.; Ruano, Rodrigo; Belfort, Michael A.; Olutoye, Oluyinka O.; Kailin, Joshua A.

In: Prenatal Diagnosis, 01.01.2018.

Research output: Contribution to journalArticle

Dhillon, Gurpreet S. ; Maskatia, Shiraz A. ; Loar, Robert W. ; Colquitt, John L. ; Mehollin-Ray, Amy R. ; Ruano, Rodrigo ; Belfort, Michael A. ; Olutoye, Oluyinka O. ; Kailin, Joshua A. / The impact of fetal endoscopic tracheal occlusion in isolated left-sided congenital diaphragmatic hernia on left-sided cardiac dimensions. In: Prenatal Diagnosis. 2018.
@article{e1d2af2645504312a03dbb3f8f182317,
title = "The impact of fetal endoscopic tracheal occlusion in isolated left-sided congenital diaphragmatic hernia on left-sided cardiac dimensions",
abstract = "Objectives: Fetal endoscopic tracheal occlusion (FETO) is offered to fetuses with congenital diaphragmatic hernia (CDH) and severe lung hypoplasia to promote lung growth and may secondarily affect left heart growth. The effects of FETO on left heart hypoplasia (LHH) are not described post-CDH repair. Methods: A retrospective analysis was performed for fetuses with left-sided CDH who underwent FETO and severity-matched controls from 2007 to 2016 at our institution. Echocardiographic, ultrasound, and MRI data were reviewed. Left heart dimensions were assessed prenatally and postnatally. Primary clinical outcome evaluated was death. Results: Twelve FETO patients and 18 controls were identified. Fetal LHH was noted in both groups and worsened after FETO. Postnatal mitral valve dimensions were larger in the FETO group pre-CDH repair (P =.03). Post-CDH repair, mitral valve and left ventricular dimensions were not significantly different between groups (P =.79 and P =.63 respectively) while FETO aortic valve dimensions were smaller (P =.04). Extracorporeal membrane oxygenation use was lower in the FETO group. No associations were found between left heart dimensions and outcomes. Conclusion: Although increased lung growth was seen after FETO, fetal LHH persisted with relative normalization seen post-repair. Persistent LHH post-FETO could be secondary to a small contribution of pulmonary venous return to the fetal left heart and increased intrathoracic pressures post-FETO.",
author = "Dhillon, {Gurpreet S.} and Maskatia, {Shiraz A.} and Loar, {Robert W.} and Colquitt, {John L.} and Mehollin-Ray, {Amy R.} and Rodrigo Ruano and Belfort, {Michael A.} and Olutoye, {Oluyinka O.} and Kailin, {Joshua A.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/pd.5333",
language = "English (US)",
journal = "Prenatal Diagnosis",
issn = "0197-3851",
publisher = "John Wiley and Sons Ltd",

}

TY - JOUR

T1 - The impact of fetal endoscopic tracheal occlusion in isolated left-sided congenital diaphragmatic hernia on left-sided cardiac dimensions

AU - Dhillon, Gurpreet S.

AU - Maskatia, Shiraz A.

AU - Loar, Robert W.

AU - Colquitt, John L.

AU - Mehollin-Ray, Amy R.

AU - Ruano, Rodrigo

AU - Belfort, Michael A.

AU - Olutoye, Oluyinka O.

AU - Kailin, Joshua A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: Fetal endoscopic tracheal occlusion (FETO) is offered to fetuses with congenital diaphragmatic hernia (CDH) and severe lung hypoplasia to promote lung growth and may secondarily affect left heart growth. The effects of FETO on left heart hypoplasia (LHH) are not described post-CDH repair. Methods: A retrospective analysis was performed for fetuses with left-sided CDH who underwent FETO and severity-matched controls from 2007 to 2016 at our institution. Echocardiographic, ultrasound, and MRI data were reviewed. Left heart dimensions were assessed prenatally and postnatally. Primary clinical outcome evaluated was death. Results: Twelve FETO patients and 18 controls were identified. Fetal LHH was noted in both groups and worsened after FETO. Postnatal mitral valve dimensions were larger in the FETO group pre-CDH repair (P =.03). Post-CDH repair, mitral valve and left ventricular dimensions were not significantly different between groups (P =.79 and P =.63 respectively) while FETO aortic valve dimensions were smaller (P =.04). Extracorporeal membrane oxygenation use was lower in the FETO group. No associations were found between left heart dimensions and outcomes. Conclusion: Although increased lung growth was seen after FETO, fetal LHH persisted with relative normalization seen post-repair. Persistent LHH post-FETO could be secondary to a small contribution of pulmonary venous return to the fetal left heart and increased intrathoracic pressures post-FETO.

AB - Objectives: Fetal endoscopic tracheal occlusion (FETO) is offered to fetuses with congenital diaphragmatic hernia (CDH) and severe lung hypoplasia to promote lung growth and may secondarily affect left heart growth. The effects of FETO on left heart hypoplasia (LHH) are not described post-CDH repair. Methods: A retrospective analysis was performed for fetuses with left-sided CDH who underwent FETO and severity-matched controls from 2007 to 2016 at our institution. Echocardiographic, ultrasound, and MRI data were reviewed. Left heart dimensions were assessed prenatally and postnatally. Primary clinical outcome evaluated was death. Results: Twelve FETO patients and 18 controls were identified. Fetal LHH was noted in both groups and worsened after FETO. Postnatal mitral valve dimensions were larger in the FETO group pre-CDH repair (P =.03). Post-CDH repair, mitral valve and left ventricular dimensions were not significantly different between groups (P =.79 and P =.63 respectively) while FETO aortic valve dimensions were smaller (P =.04). Extracorporeal membrane oxygenation use was lower in the FETO group. No associations were found between left heart dimensions and outcomes. Conclusion: Although increased lung growth was seen after FETO, fetal LHH persisted with relative normalization seen post-repair. Persistent LHH post-FETO could be secondary to a small contribution of pulmonary venous return to the fetal left heart and increased intrathoracic pressures post-FETO.

UR - http://www.scopus.com/inward/record.url?scp=85052824739&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052824739&partnerID=8YFLogxK

U2 - 10.1002/pd.5333

DO - 10.1002/pd.5333

M3 - Article

C2 - 30047996

AN - SCOPUS:85052824739

JO - Prenatal Diagnosis

JF - Prenatal Diagnosis

SN - 0197-3851

ER -