Balloon tracheal occlusion for congenital diaphragmatic hernia: Experimental studies

Toshio Chiba, Craig T. Albanese, Diana L Farmer, Christopher F. Dowd, Roy A. Filly, Geoffrey A. Machin, Michael R. Harrison

Research output: Contribution to journalArticle

44 Scopus citations

Abstract

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

Original languageEnglish (US)
Pages (from-to)1566-1570
Number of pages5
JournalJournal of Pediatric Surgery
Volume35
Issue number11
DOIs
StatePublished - 2000

Keywords

  • Congenital diaphragmatic hernia
  • Detachable silicone balloon
  • Fetal trachea
  • Fetendo clip

ASJC Scopus subject areas

  • Surgery

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  • Cite this

    Chiba, T., Albanese, C. T., Farmer, D. L., Dowd, C. F., Filly, R. A., Machin, G. A., & Harrison, M. R. (2000). Balloon tracheal occlusion for congenital diaphragmatic hernia: Experimental studies. Journal of Pediatric Surgery, 35(11), 1566-1570. https://doi.org/10.1053/jpsu.2000.18311