Fetoscopic endoluminal tracheal occlusion balloon-related side effects and their clinical impact

To document the local effects of using a balloon for Fetoscopic Endoluminal Tracheal Occlusion(FETO)and the fate of balloon(components) after re-establishment of the airways. Retrospective study on consecutive FETO cases managed at 5 centers. Outcomes were (1)the fate of balloon components; (2)tracheal diameter(TD) measured on postnatal x-ray, (3)the occurrence, (4)criteria used, and (5)eventual resolution of tracheomalacia(TM). Multiple regression was done to correlate the TD with the observed-to-expected lung-to-head ratio(O/ELHR), gestational age(GA) at FETO, and occlusion duration. TM was categorized based on (1)unspecific criteria; (2)symptoms; (3)bronchoscopy; (4)the latter two combined. The onset and disappearance, or persistence of TM, was noted. TD and the occurrence of TM were compared to a cohort of neonates with CDH who did not have FETO using Mann-Whitney or fisher’s exact test accordingly. 287 had FETO, and 208 did not. On postnatal x-ray, the metallic component was within the body in 35.8%(78/218). Of those, it was in 80.8%(63/78) in the gut, from which it was cleared in 77.8%(49/63) by 4(2–8) days. In 19.2%(15/78) the ball ended in the lung, where it persisted. In 208 fetuses without FETO, TD increased with GA (Figure). In FETO infants, the trachea was significantly wider and correlated to GA at FETO and duration of occlusion (Table). TM was reported in 5.9%(17/287), by symptoms in 23.5%(4/17), imaging in 23.5%(4/17), or both in 52.9%(9/17). In 10 out of the 13 symptomatic children, the problem was resolved. In the others, it was still present at 48 (12.5–85.3) months of age and was severe in 2. In the CDH fetuses, TM was reported in 1.4% (3/208), by combined symptoms and imaging, and in all the symptoms resolved. There was a significant difference in the occurrence of TM between groups (FETOvs.CDH,p=.018). Balloon components are frequently seen within the body and without consequences. TD is correlated to GA at FETO and duration of occlusion. Symptomatic TM is rare; when it occurs in most it will resolve, but if persisting, it may be severe.View Large Image Figure ViewerDownload Hi-res image Download (PPT)