Effectiveness Of Fetal Endoscopic Tracheal Occlusion Therapy In The Prenatal Period Of Congenital Diaphragmatic Hernia

Abstract

Congenital diaphragmatic hernia is one of the rare malformations (0.8-5 / 10000). Although there are many treatment options in the postnatal period, as the severity of the malformation increases, the response to treatment decreases. Lung development is restricted by the compression of intraabdominal organs passing through the diaphragmatic defect. The severity of pulmonary hypertension due to hypoplasia in the lung tissue is closely related to postnatal morbidity and mortality. In addition to the lung tissue, left ventricular hypoplasia may also occur due to pressure on the heart. For all these reasons, treatment options have begun to be investigated even in the prenatal period, before tissue hypoplasia develops. In the last 20 years, there have been serious developments in ultrasound and magnetic resonance devices in parallel with the developments in technology. Accordingly, lung development of fetuses with diaphragmatic hernia during prenatal period has been better followed. Fetal endoscopic tracheal occlusion is the only method that can give treatment options to patients who are found to have severely decreased lung tissue in the prenatal period, in order to increase postpartum life expectancy. With this procedure, it is aimed to collect the fluids released from the lung with a balloon placed in the trachea in the prenatal period. Because of these accumulated fluids, the lung volume expands, tissue hypoplasia decreases, and the degree of pulmonary hypertension decreases. Although the fetal tracheal occlusion procedure has improved neonatal outcomes, there is a possibility of complications depending on the way the procedure is applied. Various complications such as premature rupture of membranes and preterm labor can be seen depending on the procedure. For this reason, it is necessary to choose the candidates for the tracheal occlusion procedure well and to calculate the profit-loss ratio well. In this study, current publications of fetal endoscopic tracheal occlusion procedure were reviewed. It was investigated on which patients the procedure could be applied and what the benefits and harms might be if it was applied.