Safety and efficacy of smart tracheal occlusion device in diaphragmatic hernia lamb model.
FETO
congenital diaphragmatic hernia
efficacy
lamb
magnetic resonance
prenatal therapy
safety
sheep
trachea
unplug
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
22
07
2020
revised:
15
09
2020
accepted:
18
09
2020
pubmed:
5
10
2020
medline:
15
12
2021
entrez:
4
10
2020
Statut:
ppublish
Résumé
To investigate the efficacy and safety of the 'smart' tracheal occlusion (Smart-TO) device in fetal lambs with diaphragmatic hernia (DH). DH was created in fetal lambs on gestational day 70 (term, 145 days). Fetuses were allocated to either pregnancy continuation until term (DH group) or fetoscopic endoluminal tracheal occlusion (TO), performed using the Smart-TO balloon on gestational day 97 (DH + TO group). On gestational day 116, the presence of the balloon was confirmed on ultrasound, then the ewe was walked around a 3.0-Tesla magnetic resonance scanner for balloon deflation, which was confirmed by ultrasound immediately afterwards. At term, euthanasia was performed and the fetus retrieved. Efficacy of occlusion was assessed by the lung-to-body-weight ratio (LBWR) and lung morphometry. Safety parameters included tracheal side effects assessed by morphometry and balloon location after deflation. The unoccluded DH lambs served as a comparator. Six fetuses were included in the DH group and seven in the DH + TO group. All balloons deflated successfully and were expelled spontaneously from the airways. In the DH + TO group, in comparison to controls, the LBWR at birth was significantly higher (1.90 (interquartile range (IQR), 1.43-2.55) vs 1.07 (IQR, 0.93-1.46); P = 0.005), while on lung morphometry, the alveolar size was significantly increased (mean linear intercept, 47.5 (IQR, 45.6-48.1) vs 41.9 (IQR, 38.8-46.1) μm; P = 0.03); whereas airway complexity was lower (mean terminal bronchiolar density, 1.56 (IQR, 1.0-1.81) vs 2.23 (IQR, 2.14-2.40) br/mm In fetal lambs with DH, TO using the Smart-TO balloon is effective and safe. Occlusion can be reversed non-invasively and the deflated intact balloon expelled spontaneously from the fetal upper airways. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Identifiants
pubmed: 33012007
doi: 10.1002/uog.23135
pmc: PMC7613565
mid: EMS152838
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
105-112Subventions
Organisme : European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant
ID : 765274
Organisme : Great Ormond Street Hospital Charity Fund
Organisme : Wellcome Trust
ID : 101957
Pays : United Kingdom
Organisme : Society for Anesthesia and Resuscitation of Belgium (SARB) and by the Obstetric Anaesthetists' Association (OAA) International
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : KU Leuven (Internal Funds)
ID : Post-Doctoral Mandate 18/215
Organisme : TBM-FWO
Organisme : Engineering and Physical Sciences Research Council (EPSRC)
ID : NS/A000027/1
Organisme : Erasmus + Programme of the European Union
ID : 2013-0040
Organisme : Innovative Engineering for Health award by the Wellcome Trust
ID : WT101957
Informations de copyright
© 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Références
World J Gastroenterol. 2012 Oct 14;18(38):5324-8
pubmed: 23082048
Eur J Obstet Gynecol Reprod Biol. 1998 Dec;81(2):165-9
pubmed: 9989861
J Pediatr Surg. 1998 Feb;33(2):299-303
pubmed: 9498406
Pediatr Radiol. 2010 May;40(5):670-3
pubmed: 20352401
Am J Obstet Gynecol. 2017 Jul;217(1):78.e1-78.e11
pubmed: 28267443
PLoS Biol. 2010 Jun 29;8(6):e1000412
pubmed: 20613859
Eur J Obstet Gynecol Reprod Biol. 2000 Sep;92(1):119-26
pubmed: 10986445
Ultrasound Obstet Gynecol. 2017 Jun;49(6):704-713
pubmed: 27312047
J Pediatr Surg. 1997 Sep;32(9):1328-31
pubmed: 9314255
Br J Anaesth. 2020 May;124(5):585-593
pubmed: 32145876
Neonatology. 2016;110(1):66-74
pubmed: 27077664
Best Pract Res Clin Obstet Gynaecol. 2019 Jul;58:93-106
pubmed: 30772144
J Appl Physiol (1985). 2003 Mar;94(3):1054-62
pubmed: 12571135
Semin Pediatr Surg. 2017 Jun;26(3):123-128
pubmed: 28641748
Pediatr Pulmonol. 2000 Sep;30(3):228-40
pubmed: 10973041
Gynecol Surg. 2018;15(1):9
pubmed: 29770109
J Pediatr Gastroenterol Nutr. 2017 Jan;64(1):133-153
pubmed: 27622898
Prenat Diagn. 2019 Apr;39(5):403-408
pubmed: 30861154
Radiology. 2010 Oct;257(1):226-32
pubmed: 20713614
J Pediatr Surg. 2004 Oct;39(10):1524-31
pubmed: 15486898
Prenat Diagn. 2010 Jul;30(7):653-67
pubmed: 20572114
Ultrasound Obstet Gynecol. 2020 Oct;56(4):522-531
pubmed: 32602968
Pediatr Res. 2006 Aug;60(2):131-5
pubmed: 16864691
Ultrasound Obstet Gynecol. 2013 Jul;42(1):77-83
pubmed: 23444265
J Pediatr Surg. 2010 Apr;45(4):687-92
pubmed: 20385271
Pediatr Radiol. 2010 May;40(5):674-80
pubmed: 19894042
Am J Respir Crit Care Med. 2005 Jun 15;171(12):1395-402
pubmed: 15778486
Eur J Pediatr Surg. 2017 Aug;27(4):297-305
pubmed: 27522127
Ann Surg. 2016 Dec;264(6):929-933
pubmed: 26910202