Original articleFetal tracheal occlusion for severe congenital diaphragmatic hernia in humans: a morphometric study of lung parenchyma and muscularization of pulmonary arterioles☆
Section snippets
Methods
This study was approved by the Committee for Protection of Human Subjects Institutional Review Board at The Children's Hospital of Philadelphia (IRB# 2004-7-3848).
Clinical background
For the TO group, mean gestational age (GA) at evaluation at our institution and mean GA at fetal TO were 23.7 ± 0.7 and 27.6 ± 0.9 weeks gestation, respectively. Mean duration of TO was 32.6 ± 6.8 days. All fetuses demonstrated herniation of liver into the fetal chest on prenatal ultrasound. The lung area–to–head circumference ratio (LHR) ranged from 0.41 to 1.04 (mean, 0.79 ± 0.1). A total of 3 patients with TO were eligible for and required extracorporeal membrane oxygenation (ECMO), and 4
Discussion
The limited success of open fetal TO therapy for severe CDH [7], [8], with respect to poor neonatal outcome, can be attributed to persistent abnormalities in pulmonary function (ie, reduced gas exchange and persistent pulmonary hypertension) and prematurity of birth caused by open fetal surgery techniques. The current morphological study was undertaken to compare key aspects of lung structure that impact neonatal lung function. We found that fetal TO accelerated prenatal lung growth, as
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Presented in part at the 37th Annual Meeting of the American Pediatric Surgery Association in Hilton Head in 2006.