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This animation shows a prenatal intervention of a congenital diaphragmatic hernia, or CDH, using fetoscopic endoluminal tracheal occlusion, or FETO.

One thing to note is that it's difficult to determine with imaging exactly how large the hole in the diaphragm is, as we'll demonstrate here. What we can see more clearly is the size of the chest and how the lungs are affected.

What you are seeing here is a fetus who has no defect in the diaphragm, and the anatomy is normal. In a mild diaphragmatic hernia shown here, the left lung starts to shrink in size.

Moving up the scale of severity, next, we see a fetus with moderate diaphragmatic hernia. The left lung is getting smaller as the intestines and part of the liver push upward.

In the most severe cases, as shown here, the liver is occupying a good portion of the chest. The left lung is very small, and even the right lung is shrinking. Babies with this degree of severity of diaphragmatic hernia are good candidates for FETO, which may help to grow their lungs and improve their outcome.

The tracheal occlusion procedure is commonly performed after gestation age of between 27 weeks and 29 weeks and six days. Under ultrasound guidance, we give the baby a shot of medicine that includes pain medication and paralytics. A local anesthetic with numbing medication is injected into the mother. We then insert an introducer into the amniotic space.

This allows us to place a fetoscope, or a small camera, through the introducer into the amniotic space.

Once we locate the baby's mouth, we advance the fetoscope into the fetal trachea, or the windpipe. I'm showing the scope is in good position. The ideal position is in the main trachea below the vocal cords but above the carina before the trachea splits into the two main bronchi. We then insert a balloon into the airway. The balloon is inflated to completely occlude the trachea before it is detached and left in place. We confirm the proper position of the balloon before the fetoscope is removed. The balloon is left in place a few weeks to accelerate lung growth.

Usually, at 34 weeks gestation, the tracheal occlusion is released using one of two methods. If the baby is in the proper position, we can puncture the balloon under ultrasound guidance, as shown here. The deflated balloon is pushed out of the baby's trachea by the lung fluids and poses no risk to the baby's health. If needle puncturing is not possible, we use a grasper to hold onto the balloon while a needle punctures the balloon. The deflated balloon is then removed from the baby's airway using the grasper.

The mother and fetus are then monitored carefully for the remainder of the pregnancy. Ideally, the baby is delivered vaginally at term, with a C-section reserved for the usual obstetrical reasons.

For more information contact the Cincinnati Children’s Fetal Care Center at 1-888-FETAL59 or visit [ Ссылка ]

Credits:
Media Lab at Cincinnati Children's Animation: Jeff Cimprich, Cat Musgrove, Matt Nelson and Julia Bendon
Media Lab Direction and Additional Content Expertise: Ken Tegtmeyer, MD
Content Experts: Foong-Yen Lim, MD, Jose Peiro, MD Voiceover: Foong-Yen Lim, MD

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