Treatment of severe congenital diaphragmatic hernia by fetal tracheal occlusion: Clinical experience with fifteen cases

OBJECTIVE: Our purpose was to determine whether prenatal tracheal occlusion improves survival in a selected population of fetuses affected by severe c ongenital diaphragmatic hernia. STUDY DESIGN: Fetuses with isolated congenital diaphragmatic hernia were se lected as candidates for fetal intervention by specific criteria designed t o predict a 90% mortality rate with conventional postnatal treatment. RESULTS: Fifteen fetuses underwent tracheal occlusion with 5 survivors (33% ). Two fetuses were lost to early preterm labor. In 13 mothers, postoperati ve gestation ranged from 19 to 68 days, with a mean duration of pregnancy a fter tracheal occlusion of 38 days. The 5 survivors were hospitalized for a n average of 76 days. Despite dramatic lung growth in some fetuses after tr acheal occlusion, intensive management was required, and most deaths were c aused by respiratory insufficiency. CONCLUSION: Prenatal tracheal occlusion can result in impressive lung growt h in a subset of fetuses with severe congenital diaphragmatic hernia. Howev er, survival remains compromised by pulmonary functional abnormality and th e consequences of prematurity.