Myocardial effects of fetal endoscopic tracheal occlusion in lambs with CDH

• Published in: Prenatal diagnosis 2016-04, Vol.36 (4), p.362-367
• Main Authors: Zambaiti, Elisa, Bussani, Rossana, Calcaterra, Valeria, Zandonà, Lorenzo, Silvestri, Furio, Peiró, José Luis, Marotta, Mario, Andreatta, Erika, Pelizzo, Gloria
• Format: Article
• Language: English
• Subjects: Animals; Arteries; Cardiac output; Cardiomyocytes; Cesarean section; Diaphragms; Edema; Endoscopy; Endothelin 1; Endothelins; Enlargement; Fetoscopy; Fetuses; Gestation; Heart; Heart diseases; Heart Ventricles - pathology; Hernia; Hernias; Hernias, Diaphragmatic, Congenital - physiopathology; Hernias, Diaphragmatic, Congenital - surgery; Histology; Hypertension; Immunofluorescence; Lungs; Myocardium - pathology; Occlusion; Pilot Projects; Sheep; Staining; Trachea - surgery; Transforming growth factor-b; Vascularization; Ventricle; Wall thickness
• ISSN: 0197-3851; 1097-0223
• DOI: 10.1002/pd.4789

Introduction Fetal endoscopic tracheal occlusion in congenital diaphragmatic hernia (CDH) may reduce pulmonary hypertension and ameliorate postnatal cardiac output. The effects of sustained early (ETO) and late (LTO) tracheal occlusion on left ventricular (LV) cells in the lamb model have not been described. Materials and methods CDH was created in lambs at 70 days' gestation (term = 145 days). ETO (85 days) or LTO (105 days) was sustained till term. After cesarean section (140 days) fetuses were euthanized and hearts harvested. LV myocardial cells were studied by histological and immunofluorescence (TGF‐beta 1, endothelin‐1) assays in CDH, ETO, LTO, and the control group (two subjects per group). Small intramyocardial arteries were evaluated by traditional histology. Results LV myocardial histology in CDH and LTO was similar. ETO‐induced LV myocardial cell enlargement and increased endothelin‐1 and TGF‐beta 1 staining; a weaker immunofluorescence signal was observed in LTO compared with ETO. Myocardial vascular wall thickness was greater in CDH than in controls. ETO was associated with a vascular wall thickness within the range of controls. Conclusion With only two fetuses in each group, only an explorative evaluation was possible. The time point at which TO is performed seems to have an effect on cardiac morphology. Functional studies as well as confirmation in clinical samples are mandatory. © 2016 John Wiley & Sons, Ltd. What's Already Known About This Topic? Fetal tracheal occlusion (TO) may ameliorate the prognosis in CDH. Fetal TO improves lung size and pulmonary vascularization. Cardiac structural changes and effects after fetal TO are poorly described. Late TO promotes fetal pulmonary growth over four weeks. Early TO improves the pulmonary response in extremely severe CDH over six weeks. What Does This Study Add? Early TO stimulates myocardial cell enlargement. Early TO induces cellular edema and inhibits growth. Early TO seems to reduce the vascular arterial wall thickness. Late TO seems to protect cardiomyocytes from cell edema.