Tracheomegaly: a complication of fetal endoscopic tracheal occlusion in the treatment of congenital diaphragmatic hernia
- 172 Downloads
Fetal endoscopic tracheal occlusion (FETO) is a promising treatment for severe congenital diaphragmatic hernia, a condition that carries significant morbidity and mortality. It is hypothesised that balloon occlusion of the fetal trachea leads to an improvement in lung growth and development. The major documented complications of FETO to date are related to preterm delivery.
To report a series of five infants who developed tracheomegaly following FETO.
Materials and methods
Review of all children referred with tracheomegaly to the paediatric intensive care and tracheal service at two referral centres.
Five neonates presented with features of respiratory distress shortly after birth and were subsequently found to have marked tracheomegaly. Two neonates had tracheomalacia in addition.
There are no previous reports in the literature describing tracheomalacia, or more specifically, tracheomegaly, as a consequence of FETO. We propose that the particularly compliant fetal airway is at risk of mechanical damage from in utero balloon occlusion. This observation of a new problem in this cohort suggests a thorough evaluation of the trachea should be performed in children who have had FETO in utero. It may be that balloon occlusion of the trachea earlier in utero (before 26 weeks’ gestation) predisposes to this condition.
KeywordsCongenital diaphragmatic hernia Tracheal occlusion Tracheomegaly Fetus Infant Fetal endoscopic balloon Tracheomalacia
We are particularly grateful to Professor Kypros Nicolaides for furnishing much of the antenatal detail of the children and for the information regarding FETO. We are also grateful to innumerable paediatricians in Nottingham and Leeds for allowing us to report two of their patients. We are also grateful to the other members of the tracheal team at Great Ormond Street Hospital for Children, London, for their assistance with these difficult cases. These other team members include Ben Hartley, Colin Wallis, Mike Broadhead, Quen Mok, Alex Barnacle, Clare McLaren, Catherine Dunne, Clair Noctor and Caroline Doyle.
- 13.Adam A, Dixon AK (eds) (2008) Grainger and Allison’s diagnostic radiology: A textbook of medical imaging, 5th edn. Elsevier Churchill Livingstone, Philadelphia, p 420Google Scholar
- 17.Randomized control trial of fetoscopic endoluminal tracheal occlusion with a balloon versus expectant management during pregnancy in fetuses with left sided congenital diaphragmatic hernia and moderate pulmonary hypoplasia. University Hospital, Gasthuisberg (2008) ClinicalTrials.gov Identifier: NCT00763737. http://clinicaltrials.gov/ct2/show/NCT00763737