Dhillon Gurpreet S, Maskatia Shiraz A, Loar Robert W, Colquitt John L, Mehollin-Ray Amy R, Ruano Rodrigo, Belfort Michael A, Olutoye Oluyinka O, Kailin Joshua A
Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA.
Section of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA, USA.
Prenat Diagn. 2018 Oct;38(11):812-820. doi: 10.1002/pd.5333. Epub 2018 Aug 29.
Fetal endoscopic tracheal occlusion (FETO) is offered to fetuses with congenital diaphragmatic hernia (CDH) and severe lung hypoplasia to promote lung growth and may secondarily affect left heart growth. The effects of FETO on left heart hypoplasia (LHH) are not described post-CDH repair.
A retrospective analysis was performed for fetuses with left-sided CDH who underwent FETO and severity-matched controls from 2007 to 2016 at our institution. Echocardiographic, ultrasound, and MRI data were reviewed. Left heart dimensions were assessed prenatally and postnatally. Primary clinical outcome evaluated was death.
Twelve FETO patients and 18 controls were identified. Fetal LHH was noted in both groups and worsened after FETO. Postnatal mitral valve dimensions were larger in the FETO group pre-CDH repair (P = .03). Post-CDH repair, mitral valve and left ventricular dimensions were not significantly different between groups (P = .79 and P = .63 respectively) while FETO aortic valve dimensions were smaller (P = .04). Extracorporeal membrane oxygenation use was lower in the FETO group. No associations were found between left heart dimensions and outcomes.
Although increased lung growth was seen after FETO, fetal LHH persisted with relative normalization seen post-repair. Persistent LHH post-FETO could be secondary to a small contribution of pulmonary venous return to the fetal left heart and increased intrathoracic pressures post-FETO.
对于患有先天性膈疝（CDH）和严重肺发育不全的胎儿，采用胎儿内镜气管闭塞术（FETO）来促进肺生长，并且可能继而影响左心生长。FETO对左心发育不全（LHH）的影响在CDH修复术后尚无描述。
对2007年至2016年在我院接受FETO的左侧CDH胎儿及病情严重程度匹配的对照组进行回顾性分析。回顾超声心动图、超声和MRI数据。在产前和产后评估左心尺寸。评估的主要临床结局为死亡。
确定了12例FETO患者和18例对照组。两组均观察到胎儿LHH，且FETO后病情加重。在CDH修复术前，FETO组的产后二尖瓣尺寸更大（P = 0.03）。CDH修复术后，两组间二尖瓣和左心室尺寸无显著差异（分别为P = 0.79和P = 0.63），而FETO组的主动脉瓣尺寸较小（P = 0.04）。FETO组体外膜肺氧合的使用率较低。未发现左心尺寸与结局之间存在关联。
尽管FETO后肺生长增加，但胎儿LHH持续存在，修复后相对恢复正常。FETO后持续存在的LHH可能继发于肺静脉回流对胎儿左心的贡献较小以及FETO后胸内压力增加。
