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Category: Medical/Surgical/Diseases/Complications
Poster Session IV
To document the local effects of using a balloon for Fetoscopic Endoluminal Tracheal Occlusion(FETO)and the fate of balloon(components) after re-establishment of the airways.
Study Design:
Retrospective study on consecutive FETO cases managed at 5 centers. Outcomes were (1)the fate of balloon components; (2)tracheal diameter(TD) measured on postnatal x-ray, (3)the occurrence, (4)criteria used, and (5)eventual resolution of tracheomalacia(TM). Multiple regression was done to correlate the TD with the observed-to-expected lung-to-head ratio(O/ELHR), gestational age(GA) at FETO, and occlusion duration. TM was categorized based on (1)unspecific criteria; (2)symptoms; (3)bronchoscopy; (4)the latter two combined. The onset and disappearance, or persistence of TM, was noted. TD and the occurrence of TM were compared to a cohort of neonates with CDH who did not have FETO using Mann-Whitney or fisher’s exact test accordingly.
Results:
287 had FETO, and 208 did not. On postnatal x-ray, the metallic component was within the body in 35.8%(78/218). Of those, it was in 80.8%(63/78) in the gut, from which it was cleared in 77.8%(49/63) by 4(2–8) days. In 19.2%(15/78) the ball ended in the lung, where it persisted.
In 208 fetuses without FETO, TD increased with GA (Figure). In FETO infants, the trachea was significantly wider and correlated to GA at FETO and duration of occlusion (Table).
TM was reported in 5.9%(17/287), by symptoms in 23.5%(4/17), imaging in 23.5%(4/17), or both in 52.9%(9/17). In 10 out of the 13 symptomatic children, the problem was resolved. In the others, it was still present at 48 (12.5–85.3) months of age and was severe in 2. In the CDH fetuses, TM was reported in 1.4% (3/208), by combined symptoms and imaging, and in all the symptoms resolved. There was a significant difference in the occurrence of TM between groups (FETOvs.CDH,p=.018).
Conclusion:
Balloon components are frequently seen within the body and without consequences. TD is correlated to GA at FETO and duration of occlusion. Symptomatic TM is rare; when it occurs in most it will resolve, but if persisting, it may be severe.
David Basurto, MD
Academic Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences
Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences
KU Leuven, Vlaams-Brabant, Belgium
Kanokwaroon Watananirun, MD
My FetUZ Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences
Katholieke University Leuven
Leuven, Vlaams-Brabant, Belgium
Diane Carriere, MD
Pediatric and Neonatal Intensive Care
AP-HP Paris Saclay University, Bicêtre Hospital
Le Kremlin-Bicêtre, France, France
Juan Otaño, MD
BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona
Barcelona, Catalonia, Spain, Spain
Marianna Scuglia, MD
My FetUZ Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences
Katholieke University Leuven
Leuven, Vlaams-Brabant, Belgium
Anna Moraes de Luna Freire Vargas, MD
Department of Maternal Fetal Medicine
Santa Joana and Pro Matre Maternity Hospitals
Sao Paulo, Brazil, Brazil
Anne Gael Cordier, MD, PhD
Obstetrics and Gynecology Departement
Antoine Beclere Hospital-AP-HP, Paris Saclay University
Clamart, France, France
Jordi Prat, MD, PhD
Pediatric and Neonatal Surgery
Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona
Barcelona, Catalonia, Spain, Spain
Pedro Muñoz Fernandes, MD
Department of Pediatric Surgery
Santa Joana and Pro Matre Maternity Hospitals
Sao Paulo, Brazil, Brazil
Francesca Maria Russo, MD, PhD
Clinical fellow
University Hospitals Leuven
Leuven, Vlaams-Brabant, Belgium
Paolo De Coppi, FRCOG, MD, PhD
NIHR BRC Great Ormond Street Hospital and Institute for Child Health
University College London
London, England, United Kingdom
Olga Gomez, MD, PhD
Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
Barcelona, Catalonia, Spain, Spain
Alexandra Benachi, FRCOG, MD, PhD
Obstetrics and Gynecology Departement
Antoine Beclere Hospital-AP-HP, Paris Saclay University
Clamart, France, France
Jan Deprest, FRCOG
University Hospitals Leuven
Leuven, Vlaams-Brabant, Belgium