Balloon tracheal occlusion for congenital diaphragmatic hernia: Experimental studies

• Published in: Journal of pediatric surgery 2000-11, Vol.35 (11), p.1566-1570
• Main Authors: Chiba, Toshio, Albanese, Craig T., Farmer, Diana L., Dowd, Christopher F., Filly, Roy A., Machin, Geoffrey A., Harrison, Michael R.
• Format: Article
• Language: English
• Subjects: Balloon Occlusion - methods; Biological and medical sciences; Congenital diaphragmatic hernia; detachable silicone balloon; Embryonic and Fetal Development; Female; fetal trachea; Fetendo clip; Fetus; Gestational Age; Hernia, Diaphragmatic - therapy; Hernias, Diaphragmatic, Congenital; Humans; Medical sciences; Pneumology; Pregnancy; Probability; Regression Analysis; Respiratory system : syndromes and miscellaneous diseases; Sensitivity and Specificity; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Trachea - embryology; Tracheal Diseases - diagnostic imaging; Tracheal Diseases - therapy; Ultrasonography, Prenatal
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1053/jpsu.2000.18311

Purpose: Temporary tracheal occlusion is an effective strategy to enlarge fetal lungs, but the optimal technique to accomplish occlusion is unknown. External clips are effective when applied fetoscopically (Fetendo clip), but require a difficult fetal neck dissection. This study was undertaken to assess the feasibility of intratracheal balloon occlusion, revisiting the internal occlusion strategy. Methods: (1) The internal diameter (ID) of human fetal trachea (53 fetuses; 14 to 41 weeks' gestation) was compared using a computer-assisted image analyzer and sonography, ex vivo. (2) Volume to diameter relationship of the balloon (balloon configuration curve) was defined using an image analyzing computer. (3) Using the trachea of fetal sheep, pressures that break balloon tracheal seal (seal pressure) were investigated. Results: (1) Between 16 and 41 weeks' gestation, tracheal ID (range, 0.7 to 5.4 mm) correlates significantly with gestational age. (2) Balloon volume required to achieve tracheal seal could be determined based on the tracheal growth curve and the balloon configuration curve. (3) Tracheal seal breaking points varied depending on the tracheal specimen tested. Conclusion: Internal tracheal occlusion using a balloon is feasible with minimal tracheal damage if the balloon volume is adjusted to fetal tracheal growth. J Pediatr Surg 35:1566-1570. Copyright © 2000 by W.B. Saunders Company.