The outcomes and lung changes of fetoscopic endoluminal tracheal occlusion in fetus with diaphragmatic hernia: A single-center experience in Japan

Objectives: To evaluate the outcomes with lung changes of fetoscopic endoluminal tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH). Methods: Between 2014 and 2023, we performed FETO for severe or moderate left-sided CDH with the Kitano Grade 3 stomach position. We analyzed the pre- and post-operative ultrasound findings, pregnancy outcomes, and survival rates at six months. Results: Twenty-five patients were analyzed. The median gestational age at balloon insertion was 29.1 (range: 27.1-31.8) weeks. The median gestational age at delivery was 35.7 (range: 30.7-38.7) weeks. Pulmonary hypertension was observed in 71% (15/21) of the cases. The 6-month survival rate was 40% (10/25). The post-FETO observed-to-expected lung-area-to-head circumference ratio (o/e LHR) and differences between pre- and post-FETO values were significantly higher in survivors than in infants who died (p <0.01 and p <0.01, respectively), but pre-FETO values were not. The post-FETO cutoff value associated with the 6-month survival was 33.8%, and that of the difference between pre- and post-FETO o/e LHR was 7.8% (area under the curve=0.91 and 0.86, respectively). Conclusions: FETO can lead to an increased o/e LHR in some but not all CDH fetuses, reflecting fetal lung growth, and be associated with a survival when it exceeds the threshold.