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FETO procedure for late-diagnosed severe CDH with liver herniation
With Dr. Beth Vermesy · hosted by Dr. Jill Knepprath
Chapter 1 of 5
FETO overview
Introduction and FETO procedure overview
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The case was a late diagnosis at 28 weeks in a patient planning home birth with a midwife who had not had prior imaging
The left lobe of the liver touching the apex of the left chest indicates the entire hemi liver has herniated into that side of the chest
The fluid-filled stomach had completely herniated into the right chest because the liver was taking up the entire left side
Initial calculated lung volume on the left was just over 1 mL at 28 weeks
The O/E (observed to expected lung to head ratio) on ultrasound was 19%
The cutoff for severe CDH O/E on ultrasound is 25%
Patient was discharged on post-op day 1 but returned on post-op day 3 for preterm contractions requiring magnesium, then discharged on Procardia and vaginal progesterone
Post-removal MRI showed the right-sided stomach now midline, right lung nicely expanded, and left lung pushed the liver slightly away from the apex
Left lung volume increased from 1 mL to 23 mL, representing a 42% increase between balloon placement and removal
Intubation support and surfactant administration were performed during C-section since it was less than a week after balloon removal
Male infant delivered with birth weight 2.6 kg and Apgars of 6 and 7
Initial ventilation was on Vyvent (APRV setting), then transitioned to oscillator with low-dose fentanyl for blood pressure support, then back to Vyvent settings
Extubation occurred at 26 days of life, which is considered pretty good for severe CDH
One month after extubation, the infant developed hemoptysis with extensive workup revealing subglottic edema and narrowing that ultimately resolved
Discharge occurred on day of life 94 (approximately 3 months old), which is considered pretty good
Tracheal dilation is a very common finding in babies who had tracheal occlusion because the trachea was stretched out during pregnancy
Tracheal dilation is not felt to be clinically impactful in the long run based on follow-up data from Europe
FETO uses a fetoscope to insert a balloon into the fetal trachea to temporarily block it, trapping fluid in the lungs to allow expansion and growth
Liver herniation is especially harmful for fetal lung development because the liver is a large solid organ, unlike the bowels
FETO was performed at 29 weeks and 3 days gestation
Elective balloon removal is typically done by week 34
Balloon removal was performed at 34 weeks and 3 days
Mother presented in labor six days after balloon removal at 35 weeks and 2 days
C-section was performed due to breech presentation
Muscle flap repair was performed on day of life 9