Tracheoscopic endoluminal plugging using an inflatable device in the fetallamb model

Objective. Intra-uterine tracheal occlusion has been proposed to reverse pu lmonary hypoplasia, an important prognostic factor in congenital diaphragma tic hernia. We aimed to evaluate the feasibility and pulmonary effects of t racheoscopic tracheal obstruction with a detachable balloon. Study design. Fourteen mid-trimester fetuses out of 24 in 13 ewes underwent tracheoscopic balloon obstruction. Ten non-operated fetuses served as cont rols. Plugging was performed under fiber-tracheoscopy using a detachable ba lloon. Outcome measures consisted of: total operating time, tracheoscopy ti me, fetal survival, efficiency of plugging, and pulmonary effects. The Mann -Whitney test and linear regression were used for statistical analysis. Results. Mean operating time and tracheoscopy time were 65+/-12 and 6.6+/-3 .9 min, respectively. One intra-operative death occurred in each group. The post-operative mortality was 2/13 for cases and 2/9 for controls. In all 1 4 fetuses, the trachea was successfully obstructed. In the 11 treated anima ls born alive, the lung-to-body-weight ratio was 0.060+/-0.01, while in con trols it was 0.031+/-0.01 (P=0.0001). In a subset of six fetuses obstructed for 14-18 days, mean-terminal-bronchial density was 0.95+/-0.59, compared to 2.06+/-0.80 for controls (P=0.046). Conclusions. Using fetal tracheoscopy, the trachea can successfully be obst ructed with an inflatable balloon. Pulmonary hyperplasia is achieved when t he obstruction lasts 2 weeks. (C) 1998 Elsevier Science Ireland Ltd. All ri ghts reserved.