Echocardiographic changes in infants with severe congenital diaphragmatic hernia after fetoscopic endoluminal tracheal occlusion (FETO)

Background: Fetoscopic endoluminal tracheal occlusion (FETO) induces lung growth and may improve survival in congenital diaphragmatic hernia (CDH) but the effect on post-natal right (RV) and left (LV) ventricular size and cardiac function is unknown. Methods: Quantitative measures of heart size and function including tricuspid annular plane systolic excursion Z-score (TAPSEZ), RV fractional area change (RVFAC), RV global longitudinal and free wall strain (RVGLS, RVFWS), RV/LV ratio, LV eccentricity index (LVEI), and LV M-mode diastolic and systolic Z-scores (LVIDDZ, LVIDSZ) were compared between FETO and control patients on first post-natal echocardiogram, prior to and post CDH repair, and on last available echocardiogram using non-parametric Wilcoxon rank-sum test in a single-center, retrospective cohort study. Linear regression models evaluated change over time, adjusting for clustering and interaction of echocardiogram parameters with time. Results: Thirty-two patients (10 FETO, 22 control) met inclusion criteria. At first echocardiogram, FETO patients demonstrated lower RV/LV ratio and LVEI (p=0.01 for both) indicating less RV dilation and less ventricular septal displacement, respectively. LV hypoplasia was less severe in FETO patients (p=0.01 for both LVIDDZ and LVIDSZ) initially. After repair, FETO patients demonstrated better RV systolic function compared to control patients by FAC (p<0.01), RVGLS (p=0.02), and RVFWS (p=0.05). Over time, FETO patients demonstrated greater improvements in RV/LV ratio and LVEI but smaller increases in LV dimensions compared to control patients. Improvements in RV function were similar between the groups. Conclusion: FETO patients demonstrate differences in cardiac size and function compared to control patients.