EACH Fetoscopic endoluminal tracheal occlusion or FETO results in impressive relative increases inlung volume in cases ofsevere congenitaldiaphragmatic hernia Dr Jacques C Janireported at the annual ID: 870448
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April 1, 2006 www.obgynnews.comFetal Lung Volume Gain With FETO ImpressiveBY SHARON WORCESTER EACH Fetoscopic endolu-minal tracheal occlusion, or FETO, re-sults in impressive relative increases inlung volume in cases ofsevere congenitaldiaphragmatic hernia, Dr. Jacques C. Janireported at the annual meeting ofthe So-ciety for Maternal-Fetal Medicine.In eight fetuses with the condition whounderwent FETO, and who were followedby regular magnetic resonance imagingbeginning at 24-26 weeks gestation, themean relative increase in lung volume fromfirst MRI to near birth was 110%, comparedwith 22% in eight fetuses managed expec-tantly, said Dr. Jani ofthe University Hos-pital Gasthuisberg, Leuven, Belgium.The mean maximal increase in lung vol-ume in the FETO patients was observed 4weeks after treatment. The volume de-creased by 23%, compared with the post-treatment maximum, following balloon re-moval, which typically occurred at 34weeks gestation, but volume remainedhigher than in those managed expectantly.The fetuses in the FETO group all hadsevere congenital diaphragmatic hernia(CDH), which by definition involves liverherniation into the chest cavity. The eightwho did not undergo FETO were man-aged expectantly either because the caseswere less severe (six cases) or becauseFETO was denied (two cases). Further evaluation ofthe fetal liver inthose managed expectantly showed that liv-er herniation, present in halfofthe cases,was associated with lower increases in lungvolume; the increase was only 9% ifthe liv-er was herniated, compared with 35%when the liver was down, Dr. Jani noted.The findings show that liver position isan important factor for predicting lung vol-ume gains in fetuses with CDH, and thatin severe CDH, FETO is effective for in-creasing lung volume. These effects persistafter in utero balloon removal, he said.