1
|
Chavelas-Ochoa F, Bermúdez-Rojas MDLL, Medina-Jiménez V, Helue-Mena A, Gil-Pugliese S, Gutiérrez-Gómez I, Martínez-Rodríguez M, Gaona-Tapia CJ, Villalobos-Gómez R, Aguilar-Vidales K, Cruz-Martínez R. Double myelomeningocele repair by fetal surgery with a single micro-hysterotomy. Pediatr Neurosurg 2024:000537723. [PMID: 38342093 DOI: 10.1159/000537723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Open spina bifida (OSB) is the most common congenital anomaly of the central nervous system. It is associated with severe neurodevelopmental delay, motor impairment, hydrocephalus, and bowel and bladder dysfunction. In selected cases, intrauterine spina bifida repair has been shown to improve neonatal outcomes. Rarely, the spine can have a double defect compromising two different segments and there is a lack of evidence on the feasibility and benefits of intrauterine repair in these cases. CASE PRESENTATION We present a case with both cervicothoracic and lumbosacral myelomeningocele, Arnold-Chiari malformation type II, and bilateral ventriculomegaly, that was treated successfully at 25 weeks with open micro-neurosurgery. Double myelomeningocele was successfully treated through a single 2cm micro-hysterotomy, by performing external versions to sequentially expose and repair both defects. Weekly postoperative follow-up showed no progression of ventriculomegaly or complications attributable to the procedure. Preterm rupture of membranes prompted a conventional cesarean delivery at 32 weeks of gestation. Neurodevelopmental outcome at 20 months was within normal ranges, having achieved ambulation without orthopedic support, and with no need for ventriculoperitoneal shunting. CONCLUSION This report demonstrates for the first time the feasibility of double OSB repair through a single 2cm micro-hysterotomy, suggesting that selected isolated cases of double myelomeningocele could be candidates for fetal intervention. Further prospective studies should be carried out to assess the potential benefit of double OSB intrauterine open repair.
Collapse
|
2
|
Fernández-Ramírez A, Olivas-Martinez A, Ruiz-Manriquez J, Kauffman-Ortega E, Moctezuma-Velázquez C, Marquez-Guillen E, Contreras AG, Vilatobá M, González-Flores E, Cruz-Martínez R, Flores-García NC, García-Juárez I. Posttransplantation diabetes mellitus after liver transplant and the impact of family history of diabetes in a Mexican cohort. Rev Gastroenterol Mex (Engl Ed) 2023:S2255-534X(23)00112-3. [PMID: 37858455 DOI: 10.1016/j.rgmxen.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/08/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION AND AIMS Posttransplantation diabetes mellitus (PTDM) is a serious long-term complication that has a negative impact on graft and patient survival. The purpose of the present study was to describe the incidence of PTDM in a Mexican cohort and evaluate its association with a previous family history of diabetes (FHD). METHODS A retrospective single-center cohort study was conducted on patients undergoing liver transplantation (LT). The primary outcome was time from LT to PTDM. The diagnosis of PTDM was established using the ADA criteria. A mediation analysis that used adjusted Cox regression models and considered pretransplant prediabetes a mediator was performed, to determine the total effect and direct effect of FHD on PTDM. RESULTS A total of 152 patients were included, with a median follow-up time of 41 months; 19.2% (n = 29) had pretransplant diabetes. During the follow-up time, 15% of patients developed PTDM (n = 23), with an incidence rate of 4.71 cases/100 person-years. PTDM was significantly higher in patients with FHD, compared with those with no FHD (8.72 cases/100 person-years vs 2.04 cases/100 person-years, respectively; p = 0.001). The adjusted hazard ratio of PTDM for FHD was 4.14 (95% CI 1.60-10.7), p = 0.005) and 3.48 (95% CI 1.35-9.01, p = 0.010), when further controlled for pretransplant prediabetes. CONCLUSION The occurrence of PTDM was similar to that reported in most international studies. As with type 2 diabetes, family history plays an important role in the development of PTDM, even after accounting for pretransplant prediabetes. Patients with FHD should undergo a stricter metabolic program.
Collapse
Affiliation(s)
- A Fernández-Ramírez
- Departamento de Medicina Interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A Olivas-Martinez
- Departamento de Bioestadística, Universidad de Washington, Seattle, WA, United States
| | - J Ruiz-Manriquez
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - E Kauffman-Ortega
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - C Moctezuma-Velázquez
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - E Marquez-Guillen
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A G Contreras
- Departamento de Cirugía y Trasplante, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - M Vilatobá
- Departamento de Cirugía y Trasplante, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - E González-Flores
- Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - R Cruz-Martínez
- Departamento de Cirugía y Trasplante, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - N C Flores-García
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - I García-Juárez
- Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| |
Collapse
|
3
|
Cruz-Martínez R, Gil-Pugliese S, Enciso-Meraz JM, Villalobos-Gómez R, López-Briones H, Martínez-Rodríguez M, Bermúdez-Rojas MDLL, Medina-Jiménez V, Coronel-Cruz F, Pineda-Alemán H, García-Espinosa M, Helue-Mena A, Márquez-Dávila A, Gutiérrez-Gómez I, Chávez-González E, Rebolledo-Fernández C. Management of Late Twin-to-Twin Transfusion Syndrome beyond 26 Weeks: Comparison between Fetoscopic Laser Therapy versus Traditional Management. Fetal Diagn Ther 2023; 50:464-471. [PMID: 37517395 DOI: 10.1159/000533202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION A proportion of monochorionic diamniotic (MCDA) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) can present after 26 weeks of gestation. The aim of this study was to compare perinatal outcomes of late TTTS treated by fetoscopic laser coagulation versus traditional management with amniodrainage and/or emergency preterm cesarean delivery (CD). METHODS Retrospective cohort from January 2012 to January 2023 of consecutive MCDA twin pregnancies complicated by TTTS after 26 weeks and evaluated in our referring centers. We analyzed perinatal outcomes of cases treated with fetoscopic laser surgery at our national referral fetal surgery center in Queretaro, Mexico, and compared them with those managed with traditional management (amniodrainage and/or emergency preterm CD). The primary outcome was survival at discharge and the secondary outcome was gestational age (GA) at birth. RESULTS Among the study population, 46 TTTS cases were treated by fetoscopy at 27+6 (26+0-31+0) weeks+days and were compared with a group of 39 cases who underwent emergency preterm CD. In comparison to the group who underwent traditional management, the group treated by laser fetoscopy showed a significantly higher GA at birth (32+3 vs. 29+1 weeks+days, p < 0.001), lower frequency of preterm delivery below 37 weeks (91.3% vs. 100%, p = 0.06), 34 weeks (63.0% vs. 100%, p < 0.001), 32 weeks (50% vs. 74.4%, p = 0.02), or 30 weeks (28.3% vs. 53.8%, p = 0.01), and significantly higher perinatal survival (89.1% vs. 71.8%, p < 0.05 of at least one twin; and 65.2% vs. 38.5%, p = 0.01 of both twins, respectively). CONCLUSION MCDA twins complicated with TTTS can be treated with fetoscopic laser surgery between 26 and 31 weeks of gestation, which is a feasible and safe option, and such cases are associated with a higher GA at birth and better perinatal survival than those managed with amniodrainage and/or emergency preterm CD.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Departament of Maternal-Fetal Medicine, Children's Women's Specialty Hospital "Dr. Felipe Núñez Lara", Queretaro, Mexico
- Fetal Medicine and Surgery Center, Fetal Medicine Mexico Institute, and Fetal Medicine Mexico Foundation, Guadalajara, Mexico
| | - Savino Gil-Pugliese
- Fetal Medicine and Surgery Center, Fetal Medicine Mexico Institute, and Fetal Medicine Mexico Foundation, Guadalajara, Mexico
| | - Juan Manuel Enciso-Meraz
- Department of Maternal-Fetal Medicine, Western National Medical Center, Mexican Institute of Social Security (IMSS), Guadalajara, Mexico
| | - Rosa Villalobos-Gómez
- Fetal Medicine and Surgery Center, Fetal Medicine Mexico Institute, and Fetal Medicine Mexico Foundation, Guadalajara, Mexico
| | - Hugo López-Briones
- Fetal Medicine and Surgery Center, Fetal Medicine Mexico Institute, and Fetal Medicine Mexico Foundation, Guadalajara, Mexico
| | - Miguel Martínez-Rodríguez
- Departament of Maternal-Fetal Medicine, Children's Women's Specialty Hospital "Dr. Felipe Núñez Lara", Queretaro, Mexico
- Fetal Medicine and Surgery Center, Fetal Medicine Mexico Institute, and Fetal Medicine Mexico Foundation, Guadalajara, Mexico
| | | | - Virginia Medina-Jiménez
- State Center for Timely Prenatal Screening, Maternal, and Child Hospital Specialty, Leon, Mexico
| | - Fausto Coronel-Cruz
- Department of Maternal-Fetal Medicine, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Hugo Pineda-Alemán
- Fetal Medicine and Surgery Center, Fetal Medicine Mexico Institute, and Fetal Medicine Mexico Foundation, Guadalajara, Mexico
| | - Maritza García-Espinosa
- Department of Maternal-Fetal Medicine, High Specialty Medical Unit Gineco Obstetrics Hospital No. 4, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Antonio Helue-Mena
- Department of Maternal-Fetal Medicine, National Medical Center "La Raza", Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Alejandra Márquez-Dávila
- Fetal Medicine and Surgery Center, Fetal Medicine Mexico Institute, and Fetal Medicine Mexico Foundation, Guadalajara, Mexico
- Department of Maternal-Fetal Medicine, National Medical Center "La Raza", Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Iván Gutiérrez-Gómez
- Department of Maternal-Fetal Medicine, National Medical Center "La Raza", Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Eréndira Chávez-González
- Fetal Medicine and Surgery Center, Fetal Medicine Mexico Institute, and Fetal Medicine Mexico Foundation, Guadalajara, Mexico
- Division of Health Sciences, Department of Biomedical Sciences, Tonala Center, University of Guadalajara, Guadalajara, Mexico
| | - Carlos Rebolledo-Fernández
- Departament of Maternal-Fetal Medicine, Children's Women's Specialty Hospital "Dr. Felipe Núñez Lara", Queretaro, Mexico
| |
Collapse
|
4
|
Cruz-Martínez R, Gil-Pugliese S, Villalobos-Gómez R, Martínez-Rodríguez M, Márquez-Dávila A, López-Briones H, Chávez-González E, Méndez-González A, Pineda-Alemán H, Rebolledo-Fernández C, Barrios-Prieto E, Fajardo-Dueñas S. Fetal Laryngoscopy and Endoscopic Tracheal Intubation to Avoid ex utero Intrapartum Treatment in the Management of Fetuses with Suspected Airway Obstruction. Fetal Diagn Ther 2023; 50:472-479. [PMID: 37544292 DOI: 10.1159/000533348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Large congenital neck tumors can cause neonatal death due to airway obstruction. The aim of this study was to report outcomes of the first cohort of fetuses with neck masses and suspected airway obstruction managed with fetal laryngoscopy (FL) and fetal endoscopic tracheal intubation (FETI) to secure fetal airways and avoid ex utero intrapartum treatment (EXIT) procedure. METHODS A prospective observational cohort of consecutive fetuses with neck masses that were candidates for an EXIT procedure due to suspicion of laryngeal and/or tracheal occlusion on ultrasonographic (US) or magnetic resonance imaging (MRI) examination were recruited for FL in a tertiary referral center in Queretaro, Mexico. FETI was performed if the obstruction was confirmed by FL. Maternal and perinatal outcomes were evaluated. RESULTS Between January 2012 and March 2023, 35 cases with neck masses were evaluated. Airway obstruction was suspected in 12/35 (34.3%), either by US in 10/35 (28.6%) or by fetal MRI in 2/35 (5.7%). In all cases, FL was successfully performed at the first attempt at a median gestational age (GA) of 36+5 (range, 33+5-39+6) weeks+days, with a median surgical time of 22.5 (12-35) min. In 4 cases, airway patency was confirmed during FL and an EXIT procedure was avoided. In 8/12 cases (66.7%), airway obstruction was confirmed during fetoscopy and FETI was successfully performed at a median GA of 36+3 (33+2-38+5) weeks+days, with a median surgical time of 25.0 (range, 12-45) min. No case required an EXIT procedure. All patients underwent conventional cesarean delivery with no maternal complications and all neonates were admitted to the neonatal intensive care unit with a correctly positioned endotracheal tube (ETT) immediately after delivery. Three neonatal deaths (37.5%) were reported due to postnatal unplanned extubation, failed ETT replacement, and tumoral bleeding. CONCLUSION In fetuses with neck masses and suspected airway obstruction, FL and FETI are feasible and could replace EXIT procedures with good maternal and perinatal outcomes.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara", Queretaro, Mexico
| | - Savino Gil-Pugliese
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Rosa Villalobos-Gómez
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Miguel Martínez-Rodríguez
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara", Queretaro, Mexico
| | - Alejandra Márquez-Dávila
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Hugo López-Briones
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Eréndira Chávez-González
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
- Department of Biomedical Sciences, University Center in Tonalá of the University of Guadalajara, Guadalajara, Mexico
| | - Antonio Méndez-González
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Hugo Pineda-Alemán
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Carlos Rebolledo-Fernández
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara", Queretaro, Mexico
| | - Ernesto Barrios-Prieto
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
- Department of Maternal-Fetal Medicine, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
| | - Sergio Fajardo-Dueñas
- Department of Maternal-Fetal Medicine, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
| |
Collapse
|
5
|
Cruz-Martínez R, Pugliese SG, Villalobos-Gómez R, Martínez-Rodríguez M, Gámez-Varela A, López-Briones H, Chávez-González E, Diaz-Primera R. Flexible video fetoscopy: feasibility and outcomes of a novel modality for laser therapy in twin-to-twin transfusion syndrome presenting with inaccessible anterior placenta. Fetal Diagn Ther 2023:000528815. [PMID: 36739861 DOI: 10.1159/000528815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/13/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Identification of intertwin anastomosis may be challenging during fetoscopy in cases with complete anterior placenta. The aim of this study was to describe the technique, feasibility and outcomes of flexible video fetoscopy for laser coagulation in monochorionic (MC) twin pregnancies with twin-to-twin transfusion syndrome (TTTS) presenting with inaccessible anterior placenta. METHODS From April 2021 to March 2022, a prospective cohort of consecutive MC twin pregnancies complicated with TTTS, presenting with anterior placenta after 20 weeks was recruited. Cases with inaccessible anterior placenta during standard technique were converted into flexible video fetoscopy for completion of laser coagulation of placental anastomosis using a 270° flexible video endoscope through the same uterine port. Descriptive analysis includes feasibility, remaining anastomoses requiring laser photocoagulation, and perinatal outcomes. RESULTS A total of 45 pregnancies with TTTS were treated with fetoscopic laser therapy during the 1-year study period. Twenty-one pregnancies presented with anterior placenta after 20 weeks, which, an inaccessible vascular equator was observed in 33.3% (7/21). Flexible video fetoscopy was successfully performed in all 7 cases at a median gestational age of 22+2 (20+0-27+1) weeks+days. Visualization of the entire placental surface, coagulation of selected vessels, and exploration of the entire vascular equator were achieved in all cases. Six cases (85.7%) required additional laser coagulation due to either vascular patency despite initial coagulation with conventional fetoscopy (1/6, 16.7%), and/or remaining non-coagulated anastomoses (5/6, 83.3%). Perinatal survival of at least one twin and both twins was achieved in 85.7%, and 57.1%, respectively. DISCUSSION Flexible video fetoscopy for completion of laser coagulation of placental anastomosis is feasible and represents a good option for TTTS cases presenting after 20 weeks with inaccessible anterior placenta.
Collapse
|
6
|
Sferra SR, Miller JL, Cortes M S, Belfort MA, Cruz-Martínez R, Kunisaki SM, Baschat AA. Postnatal care setting and survival after fetoscopic tracheal occlusion for severe congenital diaphragmatic hernia: A systematic review and meta-analysis. J Pediatr Surg 2022; 57:819-825. [PMID: 35680463 DOI: 10.1016/j.jpedsurg.2022.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/03/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fetoscopic endoluminal tracheal occlusion (FETO) was recently shown to improve postnatal survival in a multicenter, randomized controlled trial of infants with severe congenital diaphragmatic hernia (CDH). However, the external validity of this study remains unclear given a lack of standardization in postnatal management approaches. The purpose of this study was to evaluate the impact of an integrated prenatal and postnatal care setting on survival outcomes in severe CDH after FETO. STUDY DESIGN A systematic review, meta-analysis, and individual participant analysis of FETO outcomes in severe CDH were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The primary outcome was survival to discharge. Subgroup analyses of patients managed in integrated versus nonintegrated settings were performed to identify predictors of outcome. RESULTS The review generated five studies (n = 192) for the meta-analysis of FETO versus expectant prenatal management. These data revealed a significant survival benefit after FETO that was restricted to an integrated setting (OR 2.97, 95% Confidence Interval 1.69-4.26). There were nine studies (n = 150) for the individual participant analysis, which showed that FETO managed in an integrated setting had significantly increased survival rates when compared to FETO treated in a nonintegrated setting (70.7% vs. 45.7%, p = 0.003). Multi-level logistic regression identified increased availability of extracorporeal membrane oxygenation (ECMO) as the strongest determinant of postnatal survival (OR=18.8, p = 0.049). CONCLUSION This systematic review shows that institutional integration of prenatal and postnatal care is associated with the highest overall survival in children with severe CDH. These data highlight the importance of a standardized, multidisciplinary approach, including access to ECMO, as a critical postnatal component in optimizing FETO outcomes in CDH.
Collapse
Affiliation(s)
- Shelby R Sferra
- Department of Surgery, Division of General Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jena L Miller
- Department of Gynecology and Obstetrics, Johns Hopkins Center for Fetal Therapy, Johns Hopkins University School of Medicine, 600N. Wolfe Street, Baltimore 21287, MD, United States
| | - Sanz Cortes M
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Rogelio Cruz-Martínez
- Department of Maternal Fetal Medicine, Fetal Medicine and Surgery Center, Medicina Fetal Mexico, Santiago de Querétaro, Mexico
| | - Shaun M Kunisaki
- Department of Surgery, Division of General Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ahmet A Baschat
- Department of Gynecology and Obstetrics, Johns Hopkins Center for Fetal Therapy, Johns Hopkins University School of Medicine, 600N. Wolfe Street, Baltimore 21287, MD, United States.
| |
Collapse
|
7
|
Khalil A, Prasad S, Cruz-Martínez R. Atypical twin-twin transfusion syndrome. Ultrasound Obstet Gynecol 2022; 60:461-469. [PMID: 35304934 DOI: 10.1002/uog.24899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, UK
| | - S Prasad
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - R Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal Mexico, Queretaro, Mexico
- Universidad Autonoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico
- Department of Fetal Surgery, Hospital de Especialidades del Niño y La Mujer 'Dr Felipe Nuñez-Lara', Queretaro, Mexico
| |
Collapse
|
8
|
Vilatobá M, González-Duarte A, Cruz-Martínez R, García-Juárez I, Leal-Villalpando R. First two cases of domino liver transplantation in Mexico. Revista de Gastroenterología de México (English Edition) 2022; 87:386-388. [DOI: 10.1016/j.rgmxen.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/06/2021] [Indexed: 10/18/2022]
|
9
|
Cruz-Martínez R, Villalobos-Gómez R, Gil-Pugliese S, Gámez-Varela A, López-Briones H, Martínez-Rodríguez M, Barrios-Prieto E. Management of atypical cases of twin-to-twin transfusion syndrome. Best Pract Res Clin Obstet Gynaecol 2022; 84:155-165. [PMID: 35490103 DOI: 10.1016/j.bpobgyn.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/13/2022] [Indexed: 11/02/2022]
Abstract
Up to 20% of monochorionic diamniotic twin pregnancies can be complicated with twin-to-twin transfusion syndrome (TTTS). This complication is diagnosed by ultrasound demonstrating amniotic fluid discordance between both amniotic sacs, with polyhydramnios in the recipient's sac and oligohydramnios in the donor's, secondary to an imbalance in blood volume exchange between twins. Ultrasound evaluation of the amniotic fluid volume, bladder filling, and assessment of fetal Doppler parameters provide the basis for classification of TTTS, allowing severity assessment. The Quintero's staging system provides a standardized prenatal estimate on the risk of intrauterine fetal demise of one or both twins and the need for fetoscopic laser coagulation of placental vascular anastomoses or delivery depending on the gestational age. However, a proportion of TTTS cases may present without a linear progressive deterioration and no ultrasound signs of preceding staging, in rare situations, they arise even without amniotic fluid discordance. Thus, these unusual clinical presentations of TTTS have long been grouped into the category of atypical TTTS. In this review, we show the clues for diagnosis and management of different atypical cases of TTTS highlighting their underlying mechanism to improve the clinical understanding of such atypical situations, avoid misdiagnosis of TTTS, and allow a timely referral to a fetoscopic center.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Guadalajara, Jalisco, Mexico; Department of Maternal-Fetal Medicine, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, Mexico; Fetal Medicine Center, Medicina Fetal México, Querétaro, Mexico.
| | - Rosa Villalobos-Gómez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Guadalajara, Jalisco, Mexico; Department of Maternal-Fetal Medicine, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, Mexico; Fetal Medicine Center, Medicina Fetal México, Querétaro, Mexico
| | | | - Alma Gámez-Varela
- Fetal Medicine and Surgery Center, Medicina Fetal México, Guadalajara, Jalisco, Mexico
| | | | - Miguel Martínez-Rodríguez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Guadalajara, Jalisco, Mexico; Department of Maternal-Fetal Medicine, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, Mexico
| | - Ernesto Barrios-Prieto
- Department of Maternal-Fetal Medicine, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, Mexico
| |
Collapse
|
10
|
Cruz-Martínez R, Hernández-Andrade E. Reply: Potential effect of maternal anesthesia on fetal hemodynamic parameters. Ultrasound Obstet Gynecol 2022; 59:131-132. [PMID: 34985818 DOI: 10.1002/uog.24823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- R Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
- Instituto de Ciencias de la Salud (ICSa), Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico
| | - E Hernández-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| |
Collapse
|
11
|
Cruz-Martínez R, Molina-Giraldo S, Etchegaray A, Ventura W, Pavón-Gómez N, Gil-Guevara E, Villalobos-Gómez R, Luna-García J, Gámez-Varela A, Martínez-Rodríguez M, López-Briones H, Chávez-González E. Prediction of neonatal survival according to lung-to-head ratio in fetuses with right congenital diaphragmatic hernia (CDH): A multicentre study from the Latin American CDH Study Group registry. Prenat Diagn 2021; 42:357-363. [PMID: 34861055 DOI: 10.1002/pd.6070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/26/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate survival outcomes of fetuses with right sided congenital diaphragmatic hernia (CDH) treated in Latin American centres and to assess the utility of left lung area to predict neonatal survival. METHODS A retrospective cohort including isolated right sided CDH cases managed expectantly during pregnancy in six tertiary centers from five Latin American countries. The utility of the observed/expected lung-to-head ratio (O/E-LHR) in predicting neonatal survival was assessed, and the best cut-off to predict prognosis was automatically selected by decision tree analysis. RESULTS A total of 99 right sided CDH cases were recruited, 58 isolated fetuses were selected at a median gestational age of 26.2 weeks, showing an overall survival rate of 26.2%. A linear trend was observed between survival and the O/E-LHR, showing that at higher O/E-LHR, the greater probability of survival (r = 0.56, p < 0.001). O/E-LHR discriminates two groups with different survival outcomes: fetuses with an O/E-LHR ≥65% showed a significantly higher survival rate than those with an O/E-LHR <65% (81.8% vs. 15.6%, p < 0.01). CONCLUSIONS Overall survival rate in right sided CDH is lower in Latin American countries. The severity category of pulmonary hypoplasia should be classified according to lung area and the survival rate in such population.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Department of Fetal Diagnosis, Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
| | - Saulo Molina-Giraldo
- Section of Fetal Therapy and Fetal Surgery Unit, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hospital de San José, Fundación Universitaria de Ciencias de la Salud - FUCS, Clínica Colsubsidio 94, FetoNetwork Colombia, Bogotá, Colombia
| | - Adolfo Etchegaray
- Department of Fetal Medicine, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Walter Ventura
- Department of Fetal Medicine, Instituto Nacional Materno Perinatal y Clínica Angloamericana, British Medical Hospital, Lima, Perú
| | - Néstor Pavón-Gómez
- Division of Maternal Fetal Medicine, Hospital Bertha Calderón Roque, Managua, Nicaragua
| | - Enrique Gil-Guevara
- Department of Fetal Diagnosis, Instituto Peruano de Medicina y Cirugía Fetal, Lima, Perú
| | - Rosa Villalobos-Gómez
- Department of Fetal Diagnosis, Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
| | - Jonahtan Luna-García
- Department of Fetal Diagnosis, Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
| | - Alma Gámez-Varela
- Department of Fetal Diagnosis, Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
| | - Miguel Martínez-Rodríguez
- Department of Fetal Diagnosis, Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
| | - Hugo López-Briones
- Department of Fetal Diagnosis, Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
| | - Eréndira Chávez-González
- Department of Fetal Diagnosis, Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
| | | |
Collapse
|
12
|
Luna-García J, Martínez-Rodríguez M, López-Saiz L, Villalobos-Gómez R, Cruz-Martínez R. Reversed blood flow in the superior sagittal sinus in hydrops fetalis. Ultrasound Obstet Gynecol 2021; 58:949-950. [PMID: 34131986 DOI: 10.1002/uog.23710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Affiliation(s)
- J Luna-García
- Fetal Medicine and Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Querétaro, Mexico
| | - M Martínez-Rodríguez
- Fetal Medicine and Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Querétaro, Mexico
- Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico
| | - L López-Saiz
- Fetal Medicine and Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Querétaro, Mexico
| | - R Villalobos-Gómez
- Fetal Medicine and Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Querétaro, Mexico
| | - R Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Querétaro, Mexico
- Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico
| |
Collapse
|
13
|
Gámez-Varela A, Martínez-Rodríguez M, López-Briones H, Chávez-González E, Villalobos-Gómez R, Cruz-Martínez R. Are pregnancies with severe fetal hydrothorax and very short cervix candidates for pleuroamniotic shunting? Ultrasound Obstet Gynecol 2021; 58:783-784. [PMID: 33998074 DOI: 10.1002/uog.23686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/27/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Affiliation(s)
- A Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - M Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
- Fetal Medicine Foundation of Mexico, Querétaro, Mexico
| | - H López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - E Chávez-González
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - R Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - R Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
- Fetal Medicine Foundation of Mexico, Querétaro, Mexico
- Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico
| |
Collapse
|
14
|
Villalobos-Gómez R, Luna-García J, Chávez-González E, Martínez-Rodríguez MI, Meza-Barrera R, Cruz-Martínez R. Incidence and outcome of fetuses with severe hydrothorax and ductus venosus agenesis treated with thoracoamniotic shunt. Ultrasound Obstet Gynecol 2021; 58:487-488. [PMID: 32936985 DOI: 10.1002/uog.23121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- R Villalobos-Gómez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
| | - J Luna-García
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
| | - E Chávez-González
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
| | - M I Martínez-Rodríguez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer 'Dr. Felipe Núñez-Lara', Querétaro, México
| | - R Meza-Barrera
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
| | - R Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, México
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer 'Dr. Felipe Núñez-Lara', Querétaro, México
- Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, México
| |
Collapse
|
15
|
Martínez-Rodríguez M, Luna-García J, López-Briones H, Villalobos-Gómez R, Saldívar-Rodríguez D, Gámez-Varela A, Chávez-González E, Cruz-Martínez R. Brain Doppler abnormalities in fetuses with open spina bifida. J Matern Fetal Neonatal Med 2021; 35:8097-8102. [PMID: 34470130 DOI: 10.1080/14767058.2021.1961728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND To describe the brain Doppler changes in fetuses with isolated open spina bifida (OSB). STUDY DESIGN Doppler ultrasound measurements including the umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, and their combination into the cerebroplacental ratio (CPR) and umbilicocerebral ratio (UCR) were performed in a cohort of fetuses with OSB. Included patients were individually matched to a control group without structural anomalies and similar gestational ages. MCA-PI and/or CPR values below the 5th centile were considered abnormal and indicative of cerebral blood redistribution, while UCR and UA-PI above the 95th centile were considered abnormal. RESULTS During the study period, 266 fetuses were recruited, 133 normally grown fetuses with OSB and 133 matched controls. Doppler recordings were successfully obtained in all fetuses at a median gestational age of 30.9 weeks. All cases showed UA-PI within normal ranges, but fetuses with OSB showed significantly higher frequency of cerebral blood redistribution (15.0 vs. 3.0%, p < .01), MCA-PI <5th centile (10.5% vs. 3.0%, p = .01), decreased CPR (9.8% vs. 2.3%, p = .01) and increased UCR (17.2 % vs 7.5 %, p =.02). The rate of cerebral blood redistribution was significantly higher in the OSB group with ventriculomegaly in comparison to those with OSB and normal lateral ventricle diameter (18.6% vs. 3.2%, respectively; p <.05). CONCLUSION A proportion of fetuses with isolated open spina bifida showed cerebral blood redistribution.
Collapse
Affiliation(s)
- M Martínez-Rodríguez
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Foundation of Mexico, Qurerétaro, México.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara", Querétaro, México
| | - J Luna-García
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Foundation of Mexico, Qurerétaro, México
| | - H López-Briones
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Foundation of Mexico, Qurerétaro, México
| | - R Villalobos-Gómez
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Foundation of Mexico, Qurerétaro, México
| | - D Saldívar-Rodríguez
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Foundation of Mexico, Qurerétaro, México
| | - A Gámez-Varela
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Foundation of Mexico, Qurerétaro, México
| | - E Chávez-González
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Foundation of Mexico, Qurerétaro, México
| | - R Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Foundation of Mexico, Qurerétaro, México.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara", Querétaro, México.,Universidad Autónomadel Estado de Hidalgo (UAEH), Hidalgo, México
| |
Collapse
|
16
|
Cruz-Martínez R, López-Briones H, Luna-García J, Martínez-Rodriguez M, Gámez-Varela A, Chávez-González E, Villalobos-Gómez R. Incidence and survival of MCDA twin pregnancies with TTTS presenting without amniotic fluid discordance due to spontaneous septostomy and treated with fetoscopy. Ultrasound Obstet Gynecol 2021; 58:488-489. [PMID: 32959414 DOI: 10.1002/uog.23129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/07/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Affiliation(s)
- R Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal, México, Querétaro, Mexico
- Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara", Querétaro, Mexico
| | - H López-Briones
- Fetal Medicine and Surgery Center, Medicina Fetal, México, Querétaro, Mexico
| | - J Luna-García
- Fetal Medicine and Surgery Center, Medicina Fetal, México, Querétaro, Mexico
| | - M Martínez-Rodriguez
- Fetal Medicine and Surgery Center, Medicina Fetal, México, Querétaro, Mexico
- Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico
| | - A Gámez-Varela
- Fetal Medicine and Surgery Center, Medicina Fetal, México, Querétaro, Mexico
| | - E Chávez-González
- Fetal Medicine and Surgery Center, Medicina Fetal, México, Querétaro, Mexico
| | - R Villalobos-Gómez
- Fetal Medicine and Surgery Center, Medicina Fetal, México, Querétaro, Mexico
| |
Collapse
|
17
|
Cruz-Martínez R, Gámez-Varela A, Cruz-Lemini M, Martínez-Rodríguez M, Luna-García J, López-Briones H, Chavelas-Ochoa F, Chávez-González E, Aguilar-Vidales K, Chávez-Vega J, Castelo-Vargas A, Rivera-Carrillo P, Hernández-Andrade E. Doppler changes in umbilical artery, middle cerebral artery, cerebroplacental ratio and ductus venosus during open fetal microneurosurgery for intrauterine open spina bifida repair. Ultrasound Obstet Gynecol 2021; 58:238-244. [PMID: 32798234 DOI: 10.1002/uog.22177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To describe changes in fetal Doppler parameters during a novel technique for open fetal microneurosurgery for open spina bifida (OSB) repair. METHODS This was a prospective study of 44 fetuses undergoing open fetal surgery for OSB repair using a novel microneurosurgery approach that is characterized by a mini-hysterotomy (diameter of 15 mm), minimal fetal manipulation and maintenance of a constant normal amniotic fluid volume throughout the procedure. Doppler velocimetry of the umbilical artery (UA), fetal middle cerebral artery (MCA) and ductus venosus (DV) was performed before the start of surgery and at prespecified timepoints during fetal surgery. UA pulsatility index (PI) > 95th percentile, DV-PI > 95th percentile, MCA-PI < 5th percentile and cerebroplacental ratio (CPR) < 5th percentile were considered abnormal. RESULTS Median gestational age at fetal surgery was 25.2 weeks (range, 22.9-27.9 weeks). Doppler recordings were successfully obtained in all cases during all timepoints throughout the surgery. As compared with Doppler values before surgery, there was a significant increase in the proportion of fetuses with MCA-PI < 5th percentile (63.6% vs 13.6%; P < 0.001), CPR < 5th percentile (65.9% vs 15.9%; P < 0.001) and DV-PI > 95th percentile (22.7% vs 0%; P = 0.01) and a non-significant increase in the proportion of fetuses with UA-PI > 95th percentile (11.4% vs 0%; P = 0.12) during fetal surgery. None of the fetuses showed absent or reversed end-diastolic velocity in the UA or absent or reversed DV a-wave at any stage during OSB repair. All abnormal Doppler parameters returned to normal after surgery. CONCLUSIONS During open fetal surgery for OSB repair, a small hysterotomy, reduced fetal manipulation and maintenance of a normal amniotic fluid volume seem to prevent severe fetal Doppler abnormalities. The mild Doppler changes observed during fetal surgery could be a manifestation of fetal adaptation to the stress of fetal surgery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- R Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
- Instituto de Ciencias de la Salud (ICSa), Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico
| | - A Gámez-Varela
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - M Cruz-Lemini
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - M Martínez-Rodríguez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Querétaro, Mexico
| | - J Luna-García
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - H López-Briones
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - F Chavelas-Ochoa
- Department of Neurosurgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Querétaro, Mexico
| | - E Chávez-González
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - K Aguilar-Vidales
- Department of Anesthesiology, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Querétaro, Mexico
| | - J Chávez-Vega
- Department of Anesthesiology, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Querétaro, Mexico
| | - A Castelo-Vargas
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - P Rivera-Carrillo
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - E Hernández-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| |
Collapse
|
18
|
Cruz-Martínez R, Shazly S, Martínez-Rodríguez M, Gámez-Varela A, Luna-García J, Juárez-Martínez I, López-Briones H, Coronel-Cruz F, Villalobos-Gómez R, Ibarra-Rios D, Ordorica-Flores R, Nieto-Zermeño J. Impact of fetal endoscopic tracheal occlusion in fetuses with congenital diaphragmatic hernia and moderate lung hypoplasia. Prenat Diagn 2021; 42:310-317. [PMID: 34132402 DOI: 10.1002/pd.5988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 03/29/2021] [Accepted: 05/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the effect of Fetal Endoscopic Tracheal Occlusion (FETO) on neonatal survival in fetuses with left congenital diaphragmatic hernia (CDH) and moderate lung hypoplasia. STUDY DESIGN CDH fetuses with moderate pulmonary hypoplasia (observed/expected lung area to head ratio between 26% and 35%, or between 36% and 45% with liver herniation) were prospectively recruited. Included patients were matched to a control group who were ineligible for FETO. Primary outcomes were survival at 28 days, at discharge, and at 6 months of age, respectively. RESULTS 58 cases were recruited, 29 treated with FETO and 29 matched controls. Median gestational age (GA) at balloon placement and removal were 29.6 and 33.6 weeks, respectively. FETO group showed significantly lower GA at delivery (35.2 vs. 37.1 weeks, respectively, p < 0.01), higher survival at 28 days (51.7 vs. 24.1%, respectively, p = 0.03), at discharge (48.3 vs. 24.1%, respectively, p = 0.06), and at six months of age (41.4 vs. 24.1%, respectively, p = 0.16), and significantly lower length of ventilatory support (17.8 vs. 32.3 days, p = 0.01) and NICU stay (34.2 vs. 58.3 days, p = <0.01) compared to controls. CONCLUSION FETO was associated with a non-significant increase in survival and significantly lower neonatal respiratory morbidity among CDH fetuses with moderate lung hypoplasia.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico.,Instituto de Ciencias en Salud (ICSA), Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico
| | - Sherif Shazly
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Miguel Martínez-Rodríguez
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Alma Gámez-Varela
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Jonahtan Luna-García
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Israel Juárez-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Hugo López-Briones
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Fausto Coronel-Cruz
- Department of Maternal-Fetal Medicine, Hospital General de México, Mexico City, Mexico
| | - Rosa Villalobos-Gómez
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Daniel Ibarra-Rios
- Department of Neonatology, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| | - Ricardo Ordorica-Flores
- Department of Pediatric Surgery, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| | - Jaime Nieto-Zermeño
- Department of Pediatric Surgery, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| |
Collapse
|
19
|
Cruz-Martínez R, Díaz R, Martínez-Rodríguez M. Early release of amniotic bands using a 1.0-mm fetoscope. Am J Obstet Gynecol 2021; 224:620-621. [PMID: 33617799 DOI: 10.1016/j.ajog.2021.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
|
20
|
Cruz-Martínez R, Martínez-Rodríguez M, Gámez-Varela A, Luna-García J, López-Briones H, Chávez-González E, Villalobos-Gómez R, Juárez-Martínez I. Fetoscopic urethral meatotomy in fetuses with lower urinary tract obstruction by congenital megalourethra. Prenat Diagn 2021; 41:772-777. [PMID: 33792084 DOI: 10.1002/pd.5946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND To describe the perinatal outcomes of fetoscopic urethral meatotomy (FUM) in fetuses with lower urinary tract obstruction (LUTO) by congenital megalourethra. STUDY DESIGN Between 2012 and 2020, 226 cases with LUTO were referred to our fetal surgery center in Queretaro, Mexico. We report the perinatal outcome of cases with LUTO by congenital megalourethra that were selected for FUM in an attempt to release the penile urethral obstruction. RESULTS Congenital megalourethra was diagnosed in 10 cases (4.4%) but only 3 cases (30%) with obstructive megalourethra and megacystis were selected for fetal surgery. Fetoscopic urethral metatotomy was successfully performed in all three cases at a median gestational age (GA) of 21.4 (18.0-26.7) weeks and with a median surgical time of 27 (12-43) min. A resolution of urethral dilatation and subsequent reduction of the penile length and normalization of both the bladder size and amniotic fluid were observed in all cases. The median GA at delivery was 35.2 (range: 30.6-38.0) weeks. There were no fetal deaths but one neonatal death (33%) secondary to renal failure and preterm delivery. CONCLUSION In fetuses with LUTO by congenital obstructive megalourethra, FUM is feasible and is associated with good perinatal outcomes.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
- Instituto de Ciencias de la Salud (ICSa), Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, México
| | - Miguel Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Querétaro, México
| | - Alma Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
| | - Jonahtan Luna-García
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
| | - Hugo López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
| | - Erendira Chávez-González
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
| | - Rosa Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
| | - Israel Juárez-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
| |
Collapse
|
21
|
García-Alanís M, Toapanta-Yanchapaxi L, Vilatobá M, Cruz-Martínez R, Contreras AG, López-Yáñez S, Flores-García N, Marquéz-Guillén E, García-Juárez I. Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists. Rev Gastroenterol Mex (Engl Ed) 2021; 86:172-187. [PMID: 33771379 DOI: 10.1016/j.rgmx.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/09/2020] [Accepted: 12/27/2020] [Indexed: 06/12/2023]
Abstract
Liver transplantation is a lifesaving treatment that improves survival and quality of life. The procedure requires adequate transplant candidate selection carried out by a multidisciplinary team. Psychosocial evaluation is a necessary part of recipient selection and its primary aims are to identify problems and psychosocial needs of the patient and his/her family, to improve transplantation outcomes. Different psychosocial conditions are considered risk factors for morbidity and mortality after transplantation. The presence of those factors per se is not an absolute contraindication, thus adequate evaluation promotes equal access to healthcare, improves results, and optimizes resources. The present review provides an overview of and guidelines for the most important psychosocial issues during the pretransplantation phase.
Collapse
Affiliation(s)
- M García-Alanís
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México.
| | - L Toapanta-Yanchapaxi
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - M Vilatobá
- Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - R Cruz-Martínez
- Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - A G Contreras
- Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - S López-Yáñez
- Departamento de Trabajo Social, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - N Flores-García
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - E Marquéz-Guillén
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - I García-Juárez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| |
Collapse
|
22
|
García-Alanís M, Toapanta-Yanchapaxi L, Vilatobá M, Cruz-Martínez R, Contreras A, López-Yáñez S, Flores-García N, Marquéz-Guillén E, García-Juárez I. Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists. Revista de Gastroenterología de México (English Edition) 2021. [DOI: 10.1016/j.rgmxen.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
23
|
Gámez-Varela A, Martínez-Rodríguez M, López-Briones H, Luna-García J, Chávez-González E, Villalobos-Gómez R, Hernandez-Andrade E, Cruz-Martínez R. Preoperative Cervical Length Predicts the Risk of Delivery within One Week after Pleuroamniotic Shunt in Fetuses with Severe Hydrothorax. Fetal Diagn Ther 2021; 48:297-303. [PMID: 33784701 DOI: 10.1159/000514912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/31/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to assess the predictive performance of preoperative cervical length (CL) for delivery within 1 week after pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax. METHODS A prospective cohort of fetuses with severe hydrothorax referred to our fetal surgery center in Querétaro, Mexico from January 2012 to July 2020. Severe fetal hydrothorax was diagnosed as an accumulation of fluid within the fetal pleural space accompanied with severe bilateral lung compression, mediastinal shift, polyhydramnios, and/or hydrops. Transvaginal CL was measured immediately before PAS, and a short cervix was defined as that <25 mm. The interval from fetal intervention to delivery, prevalence of preterm prelabor rupture of membranes (PPROMs), and associations with delivery within the first week after PAS according to a short or a normal CL, were evaluated. RESULTS Thirty-five pregnancies with severe fetal hydrothorax treated with PAS were evaluated. Median gestational age at PAS was (weeks + days) 31+2 (range, 26+0-36+1). Two (5.7%) and 7 (20.0%) cases delivered within the first 24 h and 1 week after PAS, respectively. Ten (28.6%) women had a short cervix before PAS, while 25 (71.4%) had normal preoperative CL. Women with a short cervix showed lower mean interval between fetal intervention and delivery (2.4 vs. 5.5 weeks, p = 0.01), and higher prevalence of PPROM (50 vs. 12%, p = 0.01), as compared to women with a nonshort cervix. Preoperative short cervix was associated with significantly higher risk of delivery within the first 24 h (20.0 vs. 0%, respectively, p < 0.05) and 1 week after PAS (50.0 vs. 8.0%, respectively, p < 0.01) compared with pregnancies with normal preoperative CL. CONCLUSION In pregnancies with severe fetal hydrothorax candidates for pleuroamniotic shunt, identification of a short cervix before fetal intervention can predict delivery within 1 week after the surgical procedure.
Collapse
Affiliation(s)
- Alma Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | - Miguel Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara,", Querétaro, Mexico
| | - Hugo López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | - Jonahtan Luna-García
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | | | - Rosa Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | - Edgar Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Rogelio Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico.,Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara,", Querétaro, Mexico
| |
Collapse
|
24
|
Cruz-Martínez R, Sosa Sosa C, Martínez-Rodríguez M, Gámez-Varela A, Villalobos-Gómez R, López-Briones H, Luna-García J, Chávez-González E, Juárez-Martínez I. Single Uterine Access for Bilateral Pleuroamniotic Shunting in Fetuses with Severe Hydrothorax by an Internal Rotational Maneuver: Feasibility and Outcomes between Successful and Failed Procedures. Fetal Diagn Ther 2021; 48:209-216. [PMID: 33677452 DOI: 10.1159/000513748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to describe the feasibility of single percutaneous uterine access for bilateral pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax by using an internal rotational maneuver and to compare perinatal outcomes between successful and failed procedures. METHODS A prospective cohort of 25 fetuses with isolated bilateral hydrothorax and hydrops were referred to our fetal surgery center in Queretaro, Mexico during an 8-year period. Bilateral PAS was first attempted through a percutaneous single uterine access by internal rotation of the fetus, which was achieved by using the blunt tip of the same cannula, and in case of a failed procedure, a second uterine port was used to place the second shunt. The perinatal outcomes between successful (single uterine port) and failed (2 uterine ports) fetal procedures were compared. RESULTS Placing of bilateral shunts through a percutaneous single uterine access was feasible in 15/25 (60%) cases. Overall, median GA at delivery was 35.2 weeks with a survival rate of 64.0% (16/25). Three cases were excluded due to shunt dislodgement, leaving a final population of 22 fetuses; 13/22 (59.1%) and 9/22 (40.9%) managed using 1 and 2 uterine ports, respectively. The group with bilateral PAS placement through a successful single uterine port showed a significantly higher GA at birth (36.5 vs. 32.8 weeks, p = 0.001), lower surgical time (11.0 vs. 19.0 min, p = 0.01), longer interval between fetal intervention and delivery (5.7 vs. 2.7 weeks, p = 0.01), lower risk of preterm delivery (46.2 vs. 100%, p < 0.01), and lower rate of perinatal death (15.4 vs. 55.6%, p < 0.05) than the failed procedures requiring 2 uterine ports. CONCLUSION In fetuses with severe bilateral hydrothorax and hydrops, bilateral pleuroamniotic shunting through a successful single percutaneous uterine access is feasible in up to 60% of cases and is associated with better perinatal outcomes.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico, .,Instituto de Ciencias de la Salud (ICSa), Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico, .,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara,", Queretaro, Mexico,
| | - Cristian Sosa Sosa
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Miguel Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara,", Queretaro, Mexico
| | - Alma Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Rosa Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Hugo López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Jonahtan Luna-García
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Eréndira Chávez-González
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Israel Juárez-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| |
Collapse
|
25
|
Cruz-Martínez R, Chavelas-Ochoa F, Martínez-Rodríguez M, Aguilar-Vidales K, Gámez-Varela A, Luna-García J, López-Briones H, Chávez-Vega J, Pérez-Calatayud ÁA, Díaz-Carrillo MA, Ahumada-Angulo E, Castelo-Vargas A, Chávez-González E, Juárez-Martínez I, Villalobos-Gómez R, Rebolledo-Fernández C. Open Fetal Microneurosurgery for Intrauterine Spina Bifida Repair. Fetal Diagn Ther 2021; 48:163-173. [PMID: 33582666 DOI: 10.1159/000513311] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the study was to describe the feasibility of open fetal microneurosurgery for intrauterine spina bifida (SB) repair and to compare perinatal outcomes with cases managed using the classic open fetal surgery technique. METHODS In this study, we selected a cohort of consecutive fetuses with isolated open SB referred to our fetal surgery center in Queretaro, Mexico, during a 3.5-year period (2016-2020). SB repair was performed by either classic open surgery (6- to 8-cm hysterotomy with leakage of amniotic fluid, which was replaced before uterine closure) or open microneurosurgery, which is a novel technique characterized by a 15- to 20-mm hysterotomy diameter, reduced fetal manipulation by fixing the fetal back, and maintenance of normal amniotic fluid and uterine volume during the whole surgery. Perinatal outcomes of cases operated with the classic open fetal surgery technique and open microneurosurgery were compared. RESULTS Intrauterine SB repair with a complete 3-layer correction was successfully performed in 60 cases either by classic open fetal surgery (n = 13) or open microneurosurgery (n = 47). No significant differences were observed in gestational age (GA) at fetal intervention (25.4 vs. 25.1 weeks, p = 0.38) or surgical times (107 vs. 120 min, p = 0.15) between both groups. The group with open microneurosurgery showed a significantly lower rate of oligohydramnios (0 vs. 15.4%, p = 0.01), preterm rupture of the membranes (19.0 vs. 53.8%, p = 0.01), higher GA at birth (35.1 vs. 32.7 weeks, p = 0.03), lower rate of preterm delivery <34 weeks (21.4 vs. 61.5%, p = 0.01), and lower rate of perinatal death (4.8 vs. 23.1%, p = 0.04) than the group with classic open surgery. During infant follow-up, the rate of hydrocephalus requiring ventriculoperitoneal shunting was similar between both groups (7.5 vs. 20%, p = 0.24). All patients showed an intact hysterotomy site at delivery. CONCLUSION Intrauterine spina repair by open fetal microneurosurgery is feasible and was associated with better perinatal outcomes than classic open fetal surgery.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico, .,Instituto de Ciencias de la Salud (ICSa) , Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico, .,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico,
| | - Felipe Chavelas-Ochoa
- Department of Pediatric Neurosurgery, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Miguel Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Karla Aguilar-Vidales
- Department of Anesthesiology, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Alma Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Jonahtan Luna-García
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Hugo López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Joel Chávez-Vega
- Department of Anesthesiology, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Ángel Augusto Pérez-Calatayud
- Department of Maternal Intensive Care, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Manuel Alejandro Díaz-Carrillo
- Department of Maternal Intensive Care, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Edgar Ahumada-Angulo
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Andrea Castelo-Vargas
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Eréndira Chávez-González
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Israel Juárez-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Rosa Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Carlos Rebolledo-Fernández
- Department of Maternal Fetal Medicine, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| |
Collapse
|
26
|
Cruz-Martínez R, Martínez-Rodríguez M, Gámez-Varela A, Nieto-Castro B, Luna-García J, Juárez-Martínez I, López-Briones H, Guadarrama-Mora R, Torres-Torres J, Coronel-Cruz F, Ibarra-Rios D, Ordorica-Flores R, Nieto-Zermeño J. Survival outcome in severe left-sided congenital diaphragmatic hernia with and without fetal endoscopic tracheal occlusion in a country with suboptimal neonatal management. Ultrasound Obstet Gynecol 2020; 56:516-521. [PMID: 32068928 DOI: 10.1002/uog.21993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/06/2020] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the impact of fetal endoscopic tracheal occlusion (FETO) on improving survival of fetuses with severe left-sided congenital diaphragmatic hernia (CDH), as compared with contemporaneous cases managed expectantly during pregnancy, in a country with suboptimal neonatal management. METHODS In this prospective cohort study, consecutive fetuses with isolated left-sided CDH, normal karyotype and severe pulmonary hypoplasia (defined as liver herniation and observed/expected lung-to-head circumference ratio below 26%) were selected for FETO at less than 32 weeks of gestation in a single tertiary referral center in Queretaro, Mexico. Postnatal outcome (survival up to 28 days after birth) was compared between fetuses treated with FETO and contemporaneous cases with similar lung size managed expectantly during pregnancy. RESULTS Twenty-five fetuses with isolated severe left-sided CDH treated with FETO were matched individually with 25 cases managed expectantly during pregnancy. Endotracheal placement of the balloon was performed successfully on the first attempt in all cases. The median gestational age (GA) at balloon placement was 29.1 (range, 25.6-31.8) weeks and 34.1 (range, 30.0-36.1) weeks at balloon removal. There were no technical problems with the introduction or removal of the balloon in any cases. The median GA at delivery was significantly lower in the group treated with FETO than in those managed expectantly (35.3 vs 37.7 weeks; P = 0.04). The survival rate was significantly higher in the group treated with FETO than in those without fetal intervention (32% vs 0%; P < 0.001). CONCLUSION In settings with suboptimal neonatal management, FETO was associated with improved neonatal survival in fetuses with isolated left-sided CDH and severe pulmonary hypoplasia. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- R Cruz-Martínez
- Fetal Medicine Research Center, Fetal Medicine Mexico, Queretaro, Mexico
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer 'Dr. Felipe Núñez-Lara', Queretaro, Mexico
- Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico
| | - M Martínez-Rodríguez
- Fetal Medicine Research Center, Fetal Medicine Mexico, Queretaro, Mexico
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer 'Dr. Felipe Núñez-Lara', Queretaro, Mexico
| | - A Gámez-Varela
- Fetal Medicine Research Center, Fetal Medicine Mexico, Queretaro, Mexico
| | - B Nieto-Castro
- Fetal Medicine Research Center, Fetal Medicine Mexico, Queretaro, Mexico
| | - J Luna-García
- Fetal Medicine Research Center, Fetal Medicine Mexico, Queretaro, Mexico
| | - I Juárez-Martínez
- Fetal Medicine Research Center, Fetal Medicine Mexico, Queretaro, Mexico
| | - H López-Briones
- Fetal Medicine Research Center, Fetal Medicine Mexico, Queretaro, Mexico
| | - R Guadarrama-Mora
- Fetal Medicine Research Center, Fetal Medicine Mexico, Queretaro, Mexico
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer 'Dr. Felipe Núñez-Lara', Queretaro, Mexico
| | - J Torres-Torres
- Department of Maternal-Fetal Medicine, Hospital General de Mexico, Mexico City, Mexico
| | - F Coronel-Cruz
- Department of Maternal-Fetal Medicine, Hospital General de Mexico, Mexico City, Mexico
| | - D Ibarra-Rios
- Departments of Neonatal and Pediatric Surgery, Hospital Infantil de Mexico 'Dr. Federico Gómez', Mexico City, Mexico
| | - R Ordorica-Flores
- Departments of Neonatal and Pediatric Surgery, Hospital Infantil de Mexico 'Dr. Federico Gómez', Mexico City, Mexico
| | - J Nieto-Zermeño
- Departments of Neonatal and Pediatric Surgery, Hospital Infantil de Mexico 'Dr. Federico Gómez', Mexico City, Mexico
| |
Collapse
|
27
|
Cruz-Martínez R, Gámez-Varela A, Martínez-Rodríguez M, Luna-García J, López-Briones H, Chavez-González E, Juárez-Martínez I, Razo-Nava A, Villalobos-Gómez R, Favela-Heredia C. Prenatal diagnosis of laryngo-tracheo-esophageal anomalies in fetuses with congenital diaphragmatic hernia by ultrasound evaluation of the vocal cords and fetal laryngoesophagoscopy. Prenat Diagn 2020; 40:1540-1546. [PMID: 32743809 DOI: 10.1002/pd.5806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/01/2020] [Accepted: 07/30/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND To evaluate the incidence of laryngeal ultrasound (US) abnormalities in fetuses with congenital diaphragmatic hernia (CDH) and to assess the utility of fetal laryngoesophagoscopy for prenatal diagnosis of laryngo-tracheo-esophageal anomalies. STUDY DESIGN A cohort of CDH fetuses with laryngeal ultrasound abnormalities were selected for diagnostic fetal laringoesophagoscopy in a single fetal surgery center at Queretaro, Mexico. RESULTS During the study period, 210 CDH fetuses were evaluated. US examination of the vocal cords was successfully performed in all fetuses, and abnormal ultrasound findings were observed in four cases (1.9%). Fetal laringoesophagoscopy was successfully performed in all four cases at a median gestational age of 29.5 (range, 28.1-30.6) weeks. During fetal intervention, a laryngo-tracheo-esophageal cleft (TEC) extending from the larynx to the carina (type IV) was endoscopically visualized in three cases, and laryngeal atresia coexisting with TEC was confirmed in the remaining case. Fetal karyotype was normal in all cases, but abnormal chromosomal microarray analysis was reported in two cases (50%). All cases were delivered liveborn with severe respiratory failure presenting cardiac arrest and immediate neonatal death. CONCLUSIONS Laryngeal anomalies in CDH fetuses can be presumed by ultrasound evaluation of the vocal cords and confirmed by fetal laryngoesophagoscopy during pregnancy.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico.,Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Queretaro, Mexico
| | - Alma Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Miguel Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Queretaro, Mexico
| | - Jonahtan Luna-García
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Hugo López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Eréndira Chavez-González
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Israel Juárez-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Areli Razo-Nava
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Rosa Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - César Favela-Heredia
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| |
Collapse
|
28
|
Cruz-Lemini M, Alvarado-Guaman M, Nieto-Castro B, Luna-Garcia J, Martínez-Rodríguez M, Juarez-Martínez I, Palacios-Macedo A, Cruz-Martínez R. Outcomes of hypoplastic left heart syndrome and fetal aortic valvuloplasty in a country with suboptimal postnatal management. Prenat Diagn 2019; 39:563-570. [PMID: 31050019 DOI: 10.1002/pd.5470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/25/2019] [Accepted: 04/28/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fetal aortic stenosis (AoS) may progress to hypoplastic left heart syndrome (HLHS) in utero. There are currently no data, prenatal or postnatal, describing survival of fetuses or neonates with AoS or HLHS in a country with suboptimal postnatal management. STUDY DESIGN Prospective cohort study performed in Mexico, including cases diagnosed with AoS and HLHS within a 6-year period. AoS patients fulfilling previously published criteria for evolving HLHS (eHLHS) were offered fetal aortic valvuloplasty. Outcome variables were perinatal mortality, postnatal management, type of postnatal circulation, and overall survival. RESULTS Fifty-four patients were included: 16 AoS and 38 HLHS. Eighteen patients had associated anomalies and/or an abnormal karyotype. Seventy-four percent of HLHS received comfort measures, with only three cases reporting an attempt at surgical palliation, and one survivor of the first stage. Fetal aortic valvuloplasty was performed successfully in nine cases of eHLHS. Overall postnatal survival was 44% in AoS with fetal aortic valvuloplasty, and one case (ongoing) in the HLHS group. CONCLUSIONS HLHS in Mexico carries more than a 95% risk of postnatal death, with little or no experience at surgical palliation in most centers. Fetal aortic valvuloplasty in AoS may prevent progression to HLHS and in this small cohort was associated with ≈50% survival.
Collapse
Affiliation(s)
- Mónica Cruz-Lemini
- Fetal Cardiology Unit, Hospital de Especialidades del Niño y la Mujer, Santiago de Querétaro, Queretaro, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer, Santiago de Querétaro, Queretaro, Mexico.,Division of Cardiovascular Surgery, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Monica Alvarado-Guaman
- Fetal Cardiology Unit, Hospital de Especialidades del Niño y la Mujer, Santiago de Querétaro, Queretaro, Mexico
| | - Belen Nieto-Castro
- Fetal Cardiology Unit, Hospital de Especialidades del Niño y la Mujer, Santiago de Querétaro, Queretaro, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer, Santiago de Querétaro, Queretaro, Mexico
| | - Jonathan Luna-Garcia
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer, Santiago de Querétaro, Queretaro, Mexico
| | - Miguel Martínez-Rodríguez
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer, Santiago de Querétaro, Queretaro, Mexico
| | - Israel Juarez-Martínez
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer, Santiago de Querétaro, Queretaro, Mexico
| | | | - Rogelio Cruz-Martínez
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer, Santiago de Querétaro, Queretaro, Mexico.,Fetal Medicine Mexico Foundation, Queretaro, Mexico
| |
Collapse
|
29
|
Cruz-Martínez R, Etchegaray A, Molina-Giraldo S, Nieto-Castro B, Gil Guevara E, Bustillos J, Martínez-Rodríguez M, Gámez-Varela A, Saldivar-Rodríguez D, Chávez-González E, Keller R, Russo R, Yepez-García E, Coronel-Cruz F, Torres-Torres J, Rojas-Macedo A, Ibarra-Ríos D, Ordorica-Flores R, Nieto-Zermeño J, Alcocer-Alcocer M. A multicentre study to predict neonatal survival according to lung-to-head ratio and liver herniation in fetuses with left congenital diaphragmatic hernia (CDH): Hidden mortality from the Latin American CDH Study Group Registry. Prenat Diagn 2019; 39:519-526. [PMID: 30980408 DOI: 10.1002/pd.5458] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate natural history of fetuses congenital diaphragmatic hernia (CDH) prenatally diagnosed in countries where termination of pregnancy is not legally allowed and to predict neonatal survival according to lung area and liver herniation. METHODS Prospective study including antenatally diagnosed CDH cases managed expectantly during pregnancy in six tertiary Latin American centres. The contribution of the observed/expected lung-to-head ratio (O/E-LHR) and liver herniation in predicting neonatal survival was assessed. RESULTS From the total population of 380 CDH cases, 144 isolated fetuses were selected showing an overall survival rate of 31.9% (46/144). Survivors showed significantly higher O/E-LHR (56.5% vs 34.9%; P < .001), lower proportion of liver herniation (34.8% vs 80.6%, P < .001), and higher gestational age at birth (37.8 vs 36.2 weeks, P < 0.01) than nonsurvivors. Fetuses with an O/E-LHR less than 35% showed a 3.4% of survival; those with an O/E-LHR between 35% and 45% showed 28% of survival with liver up and 50% with liver down; those with an O/E-LHR greater than 45% showed 50% of survival rate with liver up and 76.9% with liver down. CONCLUSIONS Neonatal mortality in CDH is higher in Latin American countries. The category of lung hypoplasia should be classified according to the survival rates in our Latin American CDH registry.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Unidad de Cirugía Fetal, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
| | - Adolfo Etchegaray
- Unidad de Medicina Fetal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Saulo Molina-Giraldo
- Unidad de Terapia, Cirugía Fetal y Fetoscopia, División de Medicina Materno Fetal, Departmaneto de Ginecología y Obstetricia, Hospital de San José, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | - Belen Nieto-Castro
- Unidad de Medicina Materno-Fetal, Hospital Gineco-Obstétrico "Isidro Ayora", Quito, Ecuador
| | - Enrique Gil Guevara
- Instituto Unidad de Medicina Fetal, Peruano de Medicina y Cirugía Fetal, Lima, Peru
| | - Joaquin Bustillos
- Unidad de Medicina Fetal, Hospital CIMA San Jose, San José, Costa Rica
| | | | - Alma Gámez-Varela
- Unidad de Cirugía Fetal, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
| | | | | | - Rodolfo Keller
- Unidad de Medicina Fetal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Ricardo Russo
- Unidad de Medicina Fetal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Eduardo Yepez-García
- Unidad de Medicina Materno-Fetal, Hospital Gineco-Obstétrico "Isidro Ayora", Quito, Ecuador
| | - Fausto Coronel-Cruz
- Departamento de Medicina Materno Fetal, Hospital General de México, Mexico City, Mexico
| | | | - Alejandro Rojas-Macedo
- Departamento de Neonatología, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
| | - Daniel Ibarra-Ríos
- Departamento de Cirugía Pediátrica, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| | - Ricardo Ordorica-Flores
- Departamento de Cirugía Pediátrica, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| | - Jaime Nieto-Zermeño
- Departamento de Cirugía Pediátrica, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| | - Manuel Alcocer-Alcocer
- Unidad de Cirugía Fetal, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
| | | |
Collapse
|
30
|
Cubero-Rego L, Corsi-Cabrera M, Ricardo-Garcell J, Cruz-Martínez R, Harmony T. Visual evoked potentials are similar in polysomnographically defined quiet and active sleep in healthy newborns. Int J Dev Neurosci 2018; 68:26-34. [PMID: 29698661 DOI: 10.1016/j.ijdevneu.2018.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/21/2018] [Accepted: 04/21/2018] [Indexed: 02/05/2023] Open
Abstract
Morphology and late components of evoked potentials change depending on wake-sleep stages in adults. Visual Evoked potentials (VEPs) have been frequently studied in newborns to identify abnormal development of visual pathways; however, large variability has been reported and there is uncertainty as to the effect of sleep stages on VEPs in neonates. OBJECTIVE To describe the characteristics of VEPs in one month old, healthy full-term newborns during active sleep (AS) and quiet sleep (QS), defined by simultaneous polysomnography (PSG). METHODS VEPs were obtained by monocular LEDs stimulation of each eye during AS and QS, in 20 healthy full-term newborns (gestational age 37-40 weeks) with normal birth weights and normal prenatal Doppler ultrasound indices. Latencies and amplitudes of N2, P2 and N3 components in AS and QS were compared, and their association with absolute power of EEG frequency bands, assessed. RESULTS There were no significant differences in VEP morphology, latencies and amplitudes between sleep states. Typical wave forms were obtained in all newborns in AS; however, no VEPs could be identified clearly in 3 newborns in QS; QS VEPs were less reliable than in AS: more averaging was required; correlation was significantly lower between the VEP averages; and a larger number of babies needed more than two averages to obtain replicable responses needed for clinical purposes. CONCLUSIONS These results indicate that changes in amplitude and latency of some VEP components observed in NREM and REM sleep in adults are not yet present in one month old newborns probably due to immaturity of cortical and sleep mechanisms. VEPs are more reliable during AS than QS in newborns. Systematic VEP recording during AS, and polysomnographic control to identify this stage, are highly recommended as methods that can increase there liability of neonatal VEPs.
Collapse
Affiliation(s)
- Lourdes Cubero-Rego
- Research Unit in Neurodevelopment, Institute of Neurobiology, National Autonomous University of Mexico, Querétaro, 76230, Mexico.
| | - María Corsi-Cabrera
- Research Unit in Neurodevelopment, Institute of Neurobiology, National Autonomous University of Mexico, Querétaro, 76230, Mexico; Sleep Laboratory, Faculty of Psychology, National Autonomous University of Mexico, 04510, Mexico City, Mexico.
| | - Josefina Ricardo-Garcell
- Research Unit in Neurodevelopment, Institute of Neurobiology, National Autonomous University of Mexico, Querétaro, 76230, Mexico.
| | - Rogelio Cruz-Martínez
- Research Unit in Neurodevelopment, Institute of Neurobiology, National Autonomous University of Mexico, Querétaro, 76230, Mexico; Department of Fetal Medicine and Surgery, Children's and Women's Specialty Hospital of Querétaro, 76090, Mexico.
| | - Thalía Harmony
- Research Unit in Neurodevelopment, Institute of Neurobiology, National Autonomous University of Mexico, Querétaro, 76230, Mexico.
| |
Collapse
|
31
|
Cruz-Lemini M, Valenzuela-Alcaraz B, Granados-Montiel J, Martínez JM, Crispi F, Gratacós E, Cruz-Martínez R. Characterizing cardiac dysfunction in fetuses with left congenital diaphragmatic hernia. Prenat Diagn 2018; 38:422-427. [PMID: 29572873 DOI: 10.1002/pd.5253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate cardiac function by conventional echocardiography and tissue Doppler imaging in fetuses with left congenital diaphragmatic hernia (CDH). METHODS Conventional echocardiography (myocardial performance index, ventricular filling velocities, and E/A ratios) and tissue Doppler imaging (annular myocardial peak velocities, E/E' and E'/A' ratios) in mitral, septal, and tricuspid annulus were evaluated in a cohort of 31 left-sided CDH fetuses and compared with 75 controls matched for gestational age 2:1. RESULTS In comparison to controls, CDH fetuses had prolonged isovolumetric time periods (isovolumetric contraction time 35 ms vs 28 ms, P < .001), with higher myocardial performance index (0.49 vs 0.42, P < .001) and tricuspid E/A ratios (0.77 vs 0.72, P = .033). Longitudinal function assessed by tissue Doppler showed signs of impaired relaxation (mitral lateral A' 8.0 vs 10.1 cm/s, P < .001 and an increased mitral lateral E'/A' ratio 0.93 vs 0.78, P < .001) in the CDH fetuses as compared with controls, with preserved systolic function. CONCLUSION Left CDH fetuses show echocardiographic signs of diastolic dysfunction, probably secondary to fetal heart compression, maintaining a preserved systolic function.
Collapse
Affiliation(s)
- Mónica Cruz-Lemini
- Fetal Medicine Mexico, Fetal Surgery Research Unit, Children and Women's Specialty Hospital; Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Juriquilla, Queretaro, Mexico.,BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Brenda Valenzuela-Alcaraz
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Julio Granados-Montiel
- Tissue Engineering, Cell Therapy and Regenerative Medicine Research Unit, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Josep M Martínez
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Fátima Crispi
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Eduard Gratacós
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Rogelio Cruz-Martínez
- Fetal Medicine Mexico, Fetal Surgery Research Unit, Children and Women's Specialty Hospital; Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Juriquilla, Queretaro, Mexico.,BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| |
Collapse
|
32
|
Cruz-Martínez R, Nieto-Castro B, Martínez-Rodríguez M, Gámez-Varela A, Ahumada-Angulo E, Luna-García J, Pineda-Pérez MJ, Rebolledo-Fernández C. Thoracic Changes after Full Laser Ablation of the Feeding Artery in Fetuses with Bronchopulmonary Sequestration. Fetal Diagn Ther 2017; 44:166-172. [PMID: 29207383 DOI: 10.1159/000481170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/29/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess longitudinal intrathoracic changes after fetal laser surgery in fetuses with bronchopulmonary sequestration (BPS) with hydrops and/or hydrothorax. STUDY DESIGN The presence of intrafetal fluid effusions, the lung mass volume ratio (congenital pulmonary airway malformation volume ratio [CVR]), and the observed/expected lung-to-head circumference ratio (O/E-LHR) of both lungs were evaluated in a cohort of BPS fetuses with hydrops and/or hydrothorax treated with full laser ablation of the feeding artery (FLAFA). The longitudinal changes in intrafetal fluid effusions, lung mass volume, and pulmonary growth were analyzed by survival and multilevel analysis against days after FLAFA. RESULTS FLAFA was successfully performed in 15 cases at a median gestational age of 26.9 weeks. A complete disappearance of the hydrops and hydrothorax was observed a median interval of 7.5 and 21 days after the fetal intervention, respectively. A progressive decrease in the CVR and an increment in the size of both lungs were observed after FLAFA. The O/E-LHR of the lung contralateral and ipsilateral to the side of the BPS became normal on average 8 and 10 weeks after FLAFA, respectively. CONCLUSION Fetal laser surgery with FLAFA promotes disappearance of all fetal fluid effusions, a lung mass regression sequence, and a normalization of pulmonary growth.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Fetal Surgery Department, Children's and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Cubero-Rego L, Ricardo-Garcell J, Corsi-Cabrera M, Cruz-Martínez R, Rebolledo-Fernández C, Otero-Ojeda G, Harmony T. Improving the efficiency of Auditory Brainstem Responses in newborns, using a 60 clicks/s stimulation rate. J Clin Neurosci 2017; 45:299-304. [DOI: 10.1016/j.jocn.2017.08.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
|
34
|
Palacio M, Bonet-Carne E, Cobo T, Perez-Moreno A, Sabrià J, Richter J, Kacerovsky M, Jacobsson B, García-Posada RA, Bugatto F, Santisteve R, Vives À, Parra-Cordero M, Hernandez-Andrade E, Bartha JL, Carretero-Lucena P, Tan KL, Cruz-Martínez R, Burke M, Vavilala S, Iruretagoyena I, Delgado JL, Schenone M, Vilanova J, Botet F, Yeo GS, Hyett J, Deprest J, Romero R, Gratacos E, Palacio M, Cobo T, López M, Castro D, Piraquive JP, Ramírez JC, Migliorelli F, Martínez-Terrón M, Botet F, Gratacós E, Sabrià J, Martínez SF, Gómez Roig D, Bonet-Carné E, Pérez À, Domínguez M, Coronado D, Deprest J, Richter J, DeKoninck P, Kacerovsky M, Musilova I, Bestvina T, Maly J, Kokstein Z, Jacobsson B, Cedergren L, Johansson P, Tsiartas P, Sävman K, Hallingström M, García Posadas R, González FB, Fajardo MA, Quintero Prado R, Melero Jiménez V, Benavente Fernández I, Prat RS, de la Barrera Correa B, Valencia EG, Martínez Rodríguez R, Roma Mas E, Vives Argilagós À, Rodríguez Veret A, García Cancela E, Salinas PA, Parra-Cordero M, Sepúlveda-Martínez Á, Hernández-Andrade E, Romero R, Ahn H, Bartha JL, Antolín E, Carretero Lucena P, Molina García F, Jiménez Garrido N, Tallón CC, Antón BM, Yeo G, Tan KL, Cruz-Martínez R, Martínez-Rodríguez M, Hyatt J, Burke M, Mogra R, Vavilala S, Iruretagoyena JI, Delgado JL, Schenone M, Vilanova J, Bons N. Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study. Am J Obstet Gynecol 2017; 217:196.e1-196.e14. [PMID: 28342715 DOI: 10.1016/j.ajog.2017.03.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/23/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prediction of neonatal respiratory morbidity may be useful to plan delivery in complicated pregnancies. The limited predictive performance of the current diagnostic tests together with the risks of an invasive procedure restricts the use of fetal lung maturity assessment. OBJECTIVE The objective of the study was to evaluate the performance of quantitative ultrasound texture analysis of the fetal lung (quantusFLM) to predict neonatal respiratory morbidity in preterm and early-term (<39.0 weeks) deliveries. STUDY DESIGN This was a prospective multicenter study conducted in 20 centers worldwide. Fetal lung ultrasound images were obtained at 25.0-38.6 weeks of gestation within 48 hours of delivery, stored in Digital Imaging and Communication in Medicine format, and analyzed with quantusFLM. Physicians were blinded to the analysis. At delivery, perinatal outcomes and the occurrence of neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, were registered. The performance of the ultrasound texture analysis test to predict neonatal respiratory morbidity was evaluated. RESULTS A total of 883 images were collected, but 17.3% were discarded because of poor image quality or exclusion criteria, leaving 730 observations for the final analysis. The prevalence of neonatal respiratory morbidity was 13.8% (101 of 730). The quantusFLM predicted neonatal respiratory morbidity with a sensitivity, specificity, positive and negative predictive values of 74.3% (75 of 101), 88.6% (557 of 629), 51.0% (75 of 147), and 95.5% (557 of 583), respectively. Accuracy was 86.5% (632 of 730) and positive and negative likelihood ratios were 6.5 and 0.3, respectively. CONCLUSION The quantusFLM predicted neonatal respiratory morbidity with an accuracy similar to that previously reported for other tests with the advantage of being a noninvasive technique.
Collapse
|
35
|
Cruz-Martínez R, Cruz-Lemini M, Mendez A, Illa M, García-Baeza V, Martinez JM, Gratacós E. Learning Curve for Intrapulmonary Artery Doppler in Fetuses with Congenital Diaphragmatic Hernia. Fetal Diagn Ther 2015; 39:256-60. [DOI: 10.1159/000441026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
Abstract
Objective: To assess the learning curve for intrapulmonary artery Doppler in fetuses with congenital diaphragmatic hernia (CDH). Methods: Three fetal medicine fellows with the theoretic knowledge, but without prior experience, in the evaluation of intrapulmonary artery Doppler in CDH fetuses were selected. Each trainee and 1 experienced explorer assessed the intrapulmonary artery in the contralateral lung to the side of the hernia for calculation of 2 Doppler parameters - pulsatility index (PI) and peak early diastolic reversed flow (PEDRF) - in a cohort of 90 consecutive CDH fetuses. The average difference between the 3 trainees and the expert was calculated. A difference below 15% was considered as accurate measurement. The average learning curve was delineated using the cumulative sum analysis (CUSUM). Results: Among the total 270 intrapulmonary artery Doppler measurements performed by the 3 trainees, the number of failed examinations was 14 (15.6%) and 16 (17.8%) for PI and PEDRF, respectively. The CUSUM plots demonstrate that the learning curve was achieved by 53 and 63 tests performed for calculations of the intrapulmonary artery PI and PEDRF, respectively. Conclusion: Competence in Doppler evaluation of the intrapulmonary artery in CDH fetuses is achieved only after intensive continuous training.
Collapse
|
36
|
Cruz-Martínez R, Méndez A, Pineda-Alemán H, Rebolledo-Fernández C. [The EXIT procedure: Indications, limitations, risks and progress to the fetal endoscopical tracheal intubation]. Ginecol Obstet Mex 2015; 83:58-65. [PMID: 26016317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Congenital oral and neck masses are associated with a high perinatal mortality and morbidity secondary to airway obstruction due to a mass effect of the tumor with subsequent neonatal asphyxia and/or neonatal death. In 1997, the Ex Utero Intrapartum Treatment (EXIT) technique was designed to establish a secure neonatal airway. This procedure allows neonatal tracheal intubation while the uteroplacental circulation maintains fetal oxygenation in a partial fetal delivery during cesarean section. However, it must be emphasized that this technique requires a multidisciplinary team, maternal general anesthesia, high surgery times and potential maternal risks such as placental abruption and increased maternal blood loss due to uterine atony. In addition, the clinical algorithm to obtain a neonatal airway can be quite challenging and neonatal mortality has been reported due to the inability in obtaining an airway at birth. Recently, our Mexican group described a novel minimally invasive fetoscopical technique before cesarean delivery that allows prenatal airway control by means of a fetal endoscopic tracheal intubation (FETI) under maternal peridural anesthesia. This procedure attempted to avoid the need for an EXIT procedure and its potential risks. In this review we described the indications, risks and potential benefits of the EXIT technique and its possible replacement by the fetal endoscopic tracheal intubation technique.
Collapse
|
37
|
Cruz-Martínez R. Re: influence of parity on fetal hemodynamics and amniotic fluid volume at term. T. Prior, E. Mullins, P. Bennett and S. Kumar. Ultrasound Obstet Gynecol 2014; 44: 688-692. Ultrasound Obstet Gynecol 2014; 44:631. [PMID: 25449115 DOI: 10.1002/uog.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- R Cruz-Martínez
- Department of Fetal Medicine and Surgery,Children's and Women's Specialty Hospital of Queretaro, Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Queretaro, Mexico.
| |
Collapse
|
38
|
Cruz-Martínez R, Gratacos E. [Endocopic fetal surgery]. Ginecol Obstet Mex 2014; 82:325-336. [PMID: 24937948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
At present, the fetus is already considered a "patient" and as such, can develop diseases with fatal outcome in which the only therapeutic option can be fetal surgery. Currently, fetal surgery is limited almost exclusively to endoscopic surgery. Different techniques have gained clinical acceptance for improving the prognosis of various lethal fetal pathologies. Laser therapy for twin to twin transfusion syndrome and cord occlusion in monochorionic twins with selective intrauterine growth restriction are the procedures of choice for the management of monochorionic twins complications, and are associated with survival rates of up to 80-90% for at least one fetus. In fetuses with isolated congenital diaphragmatic hernia and severe pulmonary hypoplasia, fetal endoscopic tracheal occlusion has shown to improve the survival probabilities from 5% to 55% and from 1% to 33% in left and right congenital diaphragmatic hernia, respectively, and a decrease in the rate of pulmonary hypertension and neonatal morbidity. In selected cases with low urinary tract obstruction (megacystis) and without renal failure; fetal cystoscopy is a diagnostic method that excludes the possibility of urethral stenosis or atresia and may be used to ablate posterior urethral valves by laser, restoring urethral patency and potentially preserving respiratory and bladder function. In fetuses with pulmonary masses, either primary or due to airway obstruction, there is high risk of fetal death due to cardiac compression and contralateral pulmonary hypoplasia. In such cases fetal bronchoscopy can provide a successful therapeutic option to release airway obstruction.
Collapse
|
39
|
Cruz-Martínez R, Figueras F, Bennasar M, García-Posadas R, Crispi F, Hernández-Andrade E, Gratacós E. Normal Reference Ranges from 11 to 41 Weeks Gestation of Fetal Left Modified Myocardial Performance Index by Conventional Doppler with the Use of Stringent Criteria for Delimitation of the Time Periods. Fetal Diagn Ther 2012; 32:79-86. [DOI: 10.1159/000330798] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 07/09/2011] [Indexed: 11/19/2022]
|
40
|
Cruz-Lemini M, Crispi F, Van Mieghem T, Pedraza D, Cruz-Martínez R, Acosta-Rojas R, Figueras F, Parra-Cordero M, Deprest J, Gratacós E. Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study. Fetal Diagn Ther 2012; 32:116-22. [DOI: 10.1159/000333001] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 09/12/2011] [Indexed: 11/19/2022]
|
41
|
Cruz-Martínez R, Moreno-Alvarez O, Hernández-Andrade E, Castañón M, Martínez JM, Done E, Deprest J, Gratacós E. Changes in Lung Tissue Perfusion in the Prediction of Survival in Fetuses with Congenital Diaphragmatic Hernia Treated with Fetal Endoscopic Tracheal Occlusion. Fetal Diagn Ther 2011; 29:101-7. [DOI: 10.1159/000295262] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 01/25/2010] [Indexed: 11/19/2022]
|