Experience of balloon tracheal occlusion in secondary pulmonary hypoplasia in fetuses with congenital diaphragmatic hernia

Pavlichenko M.V.

Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia, Yekaterinburg, Russia

Kosovtsova N.V.

FGBU "Ural'skiĭ nauchno-issledovatel'skiĭ institut okhrany materinstva i mladenchestva" Minzdrava Rossii, Ekaterinburg, Rossiia

Markova T.V.

Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia, Yekaterinburg, Russia

Experience of balloon tracheal occlusion in secondary pulmonary hypoplasia in fetuses with congenital diaphragmatic hernia

Authors:

Pavlichenko M.V., Kosovtsova N.V., Markova T.V.

More about the authors

Journal: Russian Bulletin of Obstetrician-Gynecologist. 2018;18(3): 52‑60

DOI: 10.17116/rosakush201818352-60

Downloaded: 45

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Pavlichenko MV, Kosovtsova NV, Markova TV. Experience of balloon tracheal occlusion in secondary pulmonary hypoplasia in fetuses with congenital diaphragmatic hernia. Russian Bulletin of Obstetrician-Gynecologist. 2018;18(3):52‑60. (In Russ.)
https://doi.org/10.17116/rosakush201818352-60

Подписка 2025-2 (Russian Bulletin of Obstetrician-Gynecologist)

Close metadata

Objective — to assess the results of using balloon tracheal occlusion in fetuses as a method of in utero surgery for secondary pulmonary hypoplasia in the presence of congenital diaphragmatic hernia. Subject and methods. During 2014—2016, the Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia, analyzed the features of the course of pregnancy and labor in 19 women and those of the course of the neonatal period, the immediate results of postnatal surgical correction, postnatal outcomes, and the results of postmortem examinations in their neonates with secondary pulmonary hypoplasia associated with congenital diaphragmatic hernia. Five fetuses with lethal pulmonary hypoplasia in the presence of left-sided false congenital diaphragmatic hernia (a study group) at 26—27 weeks’ gestation underwent surgery for this condition through in utero balloon tracheal occlusion. A comparison group consisted of 14 women and their 14 newborns with left-sided congenital diaphragmatic hernia, who had not undergone in utero surgery for this condition. The comparison was divided into 2 subgroups according to the presence of lethal congenital pulmonary hypoplasia: 1) 7 women and their newborn infants without lethal pulmonary hypoplasia and 2) 7 women and their neonates with lethal pulmonary hypoplasia in the presence of left-sided congenital diaphragmatic hernia. Results. In the study group, the gestational age of the newborn infants followed up was significantly lower than that in the comparison group (34.2±0.6 and 37.7±1.7 weeks, respectively; p=0.006). However, the babies who had undergone in utero surgery for lethal pulmonary hypoplasia in the presence of left-sided congenital diaphragmatic hernia tended to have higher one-minute and five-minute Apgar scores than those who had not used intrauterine balloon tracheal occlusion. The course of an adaptation period was identical in premature newborns with lethal pulmonary hypoplasia, who had undergone in utero correction via balloon tracheal occlusion (the study group) and full-term newborns (Subgroup 1 of the comparison group) without lethal pulmonary hypoplasia, which confirm the period of general condition stabilization and that of surgical treatment for congenital diaphragmatic hernia in the neonatal period. All the infants with lethal pulmonary hypoplasia without in utero balloon tracheal occlusion surgery (Subgroup 2 of the comparison group) were born with a severe and extremely severe condition, did not receive postnatal surfactant therapy; the severe and instable status was a contraindication to postnatal surgery for congenital diaphragmatic hernia. In the study group, fatal outcomes were observed in 2 out of the 5 babies; in Subgroup 2 of the comparison group, all 7 newborns died from lethal pulmonary hypoplasia that had developed in the presence of congenital diaphragmatic hernia, who had not undergone in utero balloon tracheal occlusion. Conclusion. Congenital diaphragmatic hernia is now a severe and difficult-to-treat condition that has a high percentage of perinatal losses. The present investigation has shown that in utero balloon tracheal occlusion with prolonged secondary fetal pulmonary hypoplasia associated with congenital diaphragmatic hernia is the surgical method of choice and a reserve for lowering neonatal mortality rates.

Keywords:

secondary pulmonary hypoplasia

congenital diaphragmatic hernia

balloon tracheal occlusion

Authors:

Pavlichenko M.V.

Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia, Yekaterinburg, Russia

Kosovtsova N.V.

FGBU "Ural'skiĭ nauchno-issledovatel'skiĭ institut okhrany materinstva i mladenchestva" Minzdrava Rossii, Ekaterinburg, Rossiia

Markova T.V.

Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia, Yekaterinburg, Russia

List of references:

Surgical diseases of childhood: a Textbook. Eds. Isakova AF, Dronov YuF, Stepanova EA, Michelson VA. Moscow: GEOTAR-Media. 2006;1:253-258. (In Russ.)
Lozovskaya II, Chepurnoy MG, Chepurnoy GI, Katsupeev VB, Rozin BG. Surgical treatment of left-sided congenital diaphragm hernias. Meditsiskii vestnik yuga Rossii. 2013;1:86-88. (In Russ.)
Guseva OI. Perinatal outcomes and prognosis in diaphragmatic hernia. Ultrazvukovaya i funtsional’naya diagnostica. 2005;6:19-27. (In Russ.)
Demidov VN, Machines NV, Podurovskaya YuV, Burov AA. Congenital diaphragmatic hernia — ultrasound diagnosis and prediction of postnatal outcome. Akusherstvo i gynekologiya. 2014;4:38-45. (In Russ.)
Demidov VN, Machines NV, Gus AI, Podurovskaya YuL, Burov AA. A rare case of congenital right diaphragmatic hernia in combination with the reverse arrangement of internal organs in the fetus. Prenatal diagnosis. 2015;14:4:343-349. (In Russ.)
Puida SA. Ultrasound prenatal diagnostics of congenital respiratory organs anomalies: Dis... cand. med. nauk. St-Petersburg. 2007;16. (In Russ.)
Harrison MR, Adzick NS, Bullard KM, Farrell JA, Howell LJ, Rosen MA, Sola A, Goldberg JD, Filly RA. Correction of congenital diaphragmatic hernia in utero. VII: A prospective trial. Pediatr Surg. 1997;32:1637-1642.
Jani J, Keller RL, Benachi A, Nicolaides KH, Favre R, Gratacos E, Laudy J, Eisenberg V, Eggink A, Vaast P, Deprest J, van Schoubroeck D, Naulaers G, Harrison M, Vandecruys H, Mitanchez D, Matis J, Delelis A, Moreno O, Tibboel D, van Heijst A, Lipitz S. Prenatal prediction of survival in isolated left-sided diaphragmatic hernia. Ultrasound Obstet Gynecol. 2006;27:1:18-22.
Deprest JA, Hyett JA, Flake AW. Current controversiesin prenatal diagnosis 4: should fetal surgery be done in all cases of severe diaphragmatic hernia? Prenat Diagn. 2009;29:1:15-19.
Deprest J, Breysem L, Gratacos E, Nicolaides K. Tracheal side effects following fetal endoscopic tracheal occlusion for severe congenital diaphragmatic hernia. Pediatr Radiol. 2010;40:670-673.
Deprest J, Nicolaides K, Gratacos E. Fetal surgery for congenital diaphragmatic hernia is back from never gone. Fetal Diagn Ther. 2011;29:6-17.
Ruano R, Duarte SA, Pimenta EJ. Comparison between fetal endoscopic tracheal occlusion using a 1.0-mm fetoscope and prenatal expectant management in severe congenital diaphragmatic hernia. Fetal Diagn Ther. 2011;29:64-70.
Ruano RA, Yoshisaki CT, da Silva MM. Randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol. 2012;39:20-27.
Peralta CF, Sbragia L, Bennini JR, Braga FAA, Sampaio RM, Machado RIR, Barini R. Fetoscopic endotracheal occlusion for severe isolated diaphragmatic hernia: initial experience from a single clinic in Brazil. Fetal Diagn Ther. 2011;29:1:71-77.
Medvedev MV, Yudina EV, Sypchenko EM. Perinatal outcomes in congenital malformations. Diaphragmatic hernia. Ultrazvukovaya diagnostika v akusherstve, gynekologii i pediatrii. 2000;8:2:98-104. (In Russ.)
Kosovtsova NV, Bashmakova NV, Kovalev VV, Potapov NN, Markova TV. Intrauterine correction of diaphragmatic hernia. Issues of Gynecology, Obstetrics and Perinatology. 2014;13:1:45-48. (In Russ.)
Avrel’kina E.V., Peretyatko L.P., Gerasimova L.I. Criteria for primary/secondary pulmonary hypoplasia in case of false left-sided congenital diaphragmatic hernia. [Electronic 17 resource] electronic scientific journal «Modern problems of science and education». 2014;4. URL: http://www.science-education.ru/118-14193
Kohno NI, Stygar AM. The method of ultrasonic diagnostics of disorders of lung development of the fetus. Ultrazvukovaya i funktsionalnaya diagnostika. 2006;5:31-39. (In Russ.)
Neurology: Methodical recommendations. Eds. Volodin NN, Burkova AS, Medvedev MI, Rogatkin SO. Classification of perinatal lesions of the nervous system and their consequences in children of the first year of life. Moscow. 2007;7-20. (In Russ.)
Bedoyan J, Blackwell S, Treadwell M. Congenital diaphragmatic hernia: associated anomalies and antenatal diagnosis. Pediar Surg Int. 2004;20:170-176.
Jani J, Keller RL, Benachi A. Prenatal prediction of survival in isolated left-sided diaphragmatic hernia. Ultrasound Obstet Gynecol. 2006;27:1:18-22.
Zhou X, Du X. Analysis of the causes of neonatal deaths at term in pregnancy induced hypertension patients. Zhonghua Fu Chan Ke Za Zhi. 1997;32:7:409-411.
Esteves JS, Moreira RA, Nassar CP. Neonatal outcome in women with preterm premature rupture of membranes (PPROM) between 18 and 26 weeks. Journal of maternal-fetal & neonatal medicine. 2016;29:7:1108-1112.
Shang JF, Chen D, Fang W, Wu Y, Cui Y, Teng F, Fu W, Wang W, Lian G, Mei S. Autopsy findings of 19 cases of pulmonary vein abnormalities associated with fetal cardiac anomalies. Zhonghua bing li xue za zhi Chinese journal of pathology. 2016;45:3:186-190.
Colby ChE, Lally KP, Hintz SR. Surfactant replacement therapy on ECMO does not improve outcome in neonates with congenital diaphragmatic hernia. J Ped Surg. 2004;39:11:1632-1637.

Close metadata