Z Geburtshilfe Neonatol 2013; 217 - V04_5
DOI: 10.1055/s-0033-1361210

Cardiac function pre and post fetal endoscopic tracheal occlusion (FETO) in fetuses with congenital malformations of the thorax

A Tenzer 1, J Degenhardt 1, C Enzensberger 1, T Kohl 2, R Axt-Fliedner 1
  • 1Division of Prenatal Medicine, Department of OB/GYN, Justus-Liebig-University, Gießen, Germany
  • 2German Center for Fetal Surgery and Minimally-Invasive Therapy, Gießen, Germany

Objective: Evaluation of pre- and post-procedure cardiac function in fetuses with severe CDH or congenital thoracic anomalies (CCAM, hydrothorax) causing mediastinal shift and cardiac compression who underwent FETO to improve survival and to reduce morbidity.

Methods: 8 fetuses who underwent FETO at our center were included. FETO was performed at 32 (30 – 33) weeks of gestation. Prior to and after the operation cardiac function was assessed by measuring TAPSE, MAPSE, Tei index, ICT, ET and IRT for the LV in pw-Doppler ultrasound as well as ICT, ET and IRT in pw-TDI for LV and RV.

Results: In all cases pre and post operative assessment of parameters was successful. Pre operative TAPSE was 8.3 mm (3.8 – 12), MAPSE was 6.2 mm (2.1 – 10.5). Time intervalls in the cardiac cycle in pw-Doppler were IVC 0.058 s (0.037 – 0.080), ET 0.152 s (0.123 – 0.203) and IVR 0.064 s (0.032 – 0.088). Tei index was 0.76 (0.057 – 1.200). Intervalls in pw-TDI for LV were IVC 0.041 s (0.013 – 0.061), ET 0.189 s (0.147 – 0.189) and IVR 0.058 s (0.029 – 0.109). For RV pw-TDI intervalls were IVC 0.047 s (0.031 – 0.059), ET 0.162 (0.115 – 0.189 and IVR 0.053 s (0.035 – 0.075).

Post operative TAPSE was 8.1 mm (4.9 – 10.3), MAPSE was 6.0 mm (3.8 – 7.6). Time intervalls in the cardiac cycle in pw-Doppler were IVC 0.045 s (0.029 – 0.061), ET 0.163 s (0.117 – 0.208) and IVR 0.058 s (0.040 – 0.077). Tei index was 0.67 (0.047 – 1.390). Intervalls in pw-TDI for the LV were IVC 0.053 s (0.04 – 0.084), ET 0.163 s (0.112 – 0.232) and IVR 0.053 s (0.027 – 0.077). For the RV pw-TDI intervalls were IVC 0.048 s (0.035 – 0.075), ET 0.173 s (0.155 – 0.198) and IVR 0.051 s (0.037 – 0.067). These differences were not significant.

Conclusion: Fetal endoscopic tracheal occlusion has no short time impact on cardiac function in fetuses with cardiac compression due to diaphragmatic hernia or thoracic malformation. As part of a prospective trial data from a larger number of cases will be available soon.