{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:56:54Z","timestamp":1790575014402,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe patterns of lung\u2010size changes after fetoscopic endoluminal tracheal occlusion (FETO) in cases of right\u2010sided congenital diaphragmatic hernia (RCDH) compared with in cases of left\u2010sided congenital diaphragmatic hernia (LCDH), and the association between lung growth and the duration of occlusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a longitudinal observational cohort study conducted at three fetal surgery centers (UZ Leuven, Leuven, Belgium; BCNatal, Barcelona, Spain; The Heart Hospital of S\u00e3o Paulo, S\u00e3o Paulo, Brazil) using similar prenatal management protocols. Inclusion criteria were pregnant women with a fetus with isolated congenital diaphragmatic hernia (CDH) that underwent FETO between July 2002 and October 2021 with a minimum of two measurements of the fetal observed\u2010to\u2010expected lung\u2010to\u2010head ratio (o\/e\u2010LHR) (one before and at least one after FETO) available. The o\/e\u2010LHR was used as a proxy for fetal lung size. Other variables were the side of the defect and gestational age at FETO and at balloon removal. Multilevel analysis was used to model longitudinal changes in fetal lung size. The changes in o\/e\u2010LHR during the occlusion period (\u2206\u2009o\/e\u2010LHR (%), referred to as \u2018change in absolute lung size\u2019) were calculated and corrected for baseline measurement (\u2018proportional\u2019 lung size change (%)) and expressed as a function of the duration of occlusion (referred to as proportional lung growth rate (%\/day)). A structural break point was used to identify a significant change in proportional lung growth rate during the occlusion period. Patterns of proportional lung\u2010size change and proportional lung growth rate were compared between RCDH and LCDH using Student's\n                      <jats:italic>t<\/jats:italic>\n                      \u2010test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We reported 1026 o\/e\u2010LHR measurements in 338 fetuses (RCDH,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200973; LCDH,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009265). The pattern of lung growth after FETO was comparable in cases of RCDH and LCDH, with a sharp increase in size immediately after occlusion (60%\n                      <jats:italic>vs<\/jats:italic>\n                      50%, respectively, compared with baseline measurements), followed by a slower increase over the remainder of the observation period. Overall, over the 6\u2010week period, lung size in cases of RCDH expanded by 140% compared with baseline, while in cases of LCDH lung size expanded by 100% (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). The pattern of proportional lung growth rate was also similar, starting with a high growth rate at day\u20092 after FETO, followed by slower but persistent growth. In cases of RCDH, lungs had a slower initial growth rate compared with LCDH (13.11%\/day (95%\u2009CI, 3.72\u201322.52%\/day)\n                      <jats:italic>vs<\/jats:italic>\n                      15.67%\/day (95%\u2009CI, 6.69\u201324.66%\/day);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). The proportional growth rates over the 6\u2010week period were comparable between RCDH and LCDH (2.91%\/day\n                      <jats:italic>vs<\/jats:italic>\n                      1.84%\/day;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.081). The structural break point showed a significant change in growth rate at day\u20095 and day 31 after FETO for cases of LCDH and day\u20098 after FETO for cases of RCDH.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There are measurable differences in proportional lung growth rates after FETO between cases of RCDH and LCDH. However, the pattern of lung\u2010size changes parallel each other, with an initial fast growth rate that dropped to a lower but persisting rate later in the occlusion period. The continued increase in fetal lung size observed after FETO supports previous observations that the duration of occlusion may influence the treatment response in CDH. \u00a9 2026 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.70308","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T21:39:32Z","timestamp":1786657172000},"page":"372-379","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of right\u2010\n                    <i>vs<\/i>\n                    left\u2010sided congenital diaphragmatic hernia and duration of tracheal occlusion on longitudinal lung\u2010size changes"],"prefix":"10.1002","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5622-4183","authenticated-orcid":false,"given":"K.","family":"Watananirun","sequence":"first","affiliation":[{"name":"My FetUZ Fetal Research Center, Department of Development and Regeneration Cluster Women and Child, Biomedical Sciences, KU Leuven  Leuven Belgium"},{"name":"Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2022-9027","authenticated-orcid":false,"given":"D.","family":"Basurto","sequence":"additional","affiliation":[{"name":"My FetUZ Fetal Research Center, Department of Development and Regeneration Cluster Women and Child, Biomedical Sciences, KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4711-3857","authenticated-orcid":false,"given":"R. J.","family":"Martinez\u2010Portilla","sequence":"additional","affiliation":[{"name":"Clinical Research Division, Evidence\u2010Based Medicine Department National Institute of Perinatology IMPER  Mexico City Mexico"},{"name":"BCNatal (Hospital Cl\u00ednic and Hospital Sant Joan de Deu), Fetal I+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia I Neonatologia, IDIBAPS, CIBER\u2010ER University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6086-9486","authenticated-orcid":false,"given":"O.","family":"Gomez","sequence":"additional","affiliation":[{"name":"BCNatal (Hospital Cl\u00ednic and Hospital Sant Joan de Deu), Fetal I+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia I Neonatologia, IDIBAPS, CIBER\u2010ER University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2970-9269","authenticated-orcid":false,"given":"A. M. L. F.","family":"Vargas","sequence":"additional","affiliation":[{"name":"The Heart Hospital of S\u00e3o Paulo  S\u00e3o Paulo Brazil"},{"name":"Gestar Fetal Surgery Center  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5029-7899","authenticated-orcid":false,"given":"F. M.","family":"Russo","sequence":"additional","affiliation":[{"name":"My FetUZ Fetal Research Center, Department of Development and Regeneration Cluster Women and Child, Biomedical Sciences, KU Leuven  Leuven Belgium"},{"name":"Clinical Department of Obstetrics and Gynaecology, Fetal Medicine Unit University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5287-9673","authenticated-orcid":false,"given":"L.","family":"De Catte","sequence":"additional","affiliation":[{"name":"My FetUZ Fetal Research Center, Department of Development and Regeneration Cluster Women and Child, Biomedical Sciences, KU Leuven  Leuven Belgium"},{"name":"Clinical Department of Obstetrics and Gynaecology, Fetal Medicine Unit University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9884-5778","authenticated-orcid":false,"given":"L.","family":"Lewi","sequence":"additional","affiliation":[{"name":"My FetUZ Fetal Research Center, Department of Development and Regeneration Cluster Women and Child, Biomedical Sciences, KU Leuven  Leuven Belgium"},{"name":"Clinical Department of Obstetrics and Gynaecology, Fetal Medicine Unit University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7837-4684","authenticated-orcid":false,"given":"R.","family":"Devlieger","sequence":"additional","affiliation":[{"name":"My FetUZ Fetal Research Center, Department of Development and Regeneration Cluster Women and Child, Biomedical Sciences, KU Leuven  Leuven Belgium"},{"name":"Clinical Department of Obstetrics and Gynaecology, Fetal Medicine Unit University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7279-5311","authenticated-orcid":false,"given":"C. 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