{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:04:42Z","timestamp":1779689082281,"version":"3.53.1"},"reference-count":28,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Congenital diaphragmatic hernia (CDH) is a severe developmental defect characterized by pulmonary hypoplasia, pulmonary hypertension, and cardiac dysfunction. Fetoscopic endoluminal tracheal occlusion (FETO) is a prenatal intervention used in severe CDH to stimulate lung growth, yet its effects on fetal cardiac function remain insufficiently understood. This systematic review aimed to evaluate the impact of FETO on cardiac structure and function in fetuses with CDH. A comprehensive literature search identified four studies that met the inclusion criteria. Most studies were retrospective and showed considerable heterogeneity in study design. Overall, the available evidence suggests that FETO does not negatively affect fetal cardiac function and may promote favorable cardiac remodeling. Several studies reported improved growth of left-sided cardiac structures and better right ventricular performance in FETO-treated fetuses compared with severity-matched controls. Given the limited number of studies and their methodological variability, these findings should be interpreted with caution. Further well-designed, prospective studies with standardized cardiac assessment protocols and clearly defined outcome measures are needed to better characterize the cardiovascular effects of FETO in CDH.<\/jats:p>","DOI":"10.3390\/life16050813","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T05:33:54Z","timestamp":1779687234000},"page":"813","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac Function in Fetuses with Congenital Diaphragmatic Hernia (CDH) Before and After Fetoscopic Endoluminal Tracheal Occlusion (FETO)\u2014A Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Emilia","family":"Piotrkowicz","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Perinatology, Gynecology and Reproductive Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Przemys\u0142aw","family":"Kosi\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Perinatology, Gynecology and Reproductive Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.5603\/GP.a2017.0005","article-title":"Congenital diaphragmatic hernia: Pathogenesis, prenatal diagnosis and management\u2014Literature review","volume":"88","year":"2017","journal-title":"Ginekol. Pol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/978-90-481-9485-8_20","article-title":"The prevalence of congenital anomalies in Europe","volume":"686","author":"Dolk","year":"2010","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1097\/SLA.0000000000005113","article-title":"Mortality in Congenital Diaphragmatic Hernia: A Multicenter Registry Study of Over 5000 Patients Over 25 Years","volume":"277","author":"Gupta","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1002\/bdra.23093","article-title":"Dietary vitamin A intake below the recommended daily intake during pregnancy and the risk of congenital diaphragmatic hernia in the offspring","volume":"97","author":"Beurskens","year":"2013","journal-title":"Birth Defects Res. Part A Clin. Mol. Teratol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1002\/(SICI)1096-8628(19980923)79:3<215::AID-AJMG13>3.0.CO;2-K","article-title":"Congenital diaphragmatic defects and associated syndromes, malformations, and chromosome anomalies: A retrospective study of 60 patients and literature review","volume":"79","author":"Enns","year":"1998","journal-title":"Am. J. Med. Genet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1053\/j.semperi.2005.04.002","article-title":"Antenatal diagnosis of congenital diaphragmatic hernia","volume":"29","author":"Graham","year":"2005","journal-title":"Semin. Perinatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/S0022-3468(97)90212-8","article-title":"Familial diaphragmatic agenesis: An autosomal-recessive syndrome with a poor prognosis","volume":"32","author":"Gibbs","year":"1997","journal-title":"J. Pediatr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1159\/000322844","article-title":"Fetal surgery for congenital diaphragmatic hernia is back from never gone","volume":"29","author":"Deprest","year":"2011","journal-title":"Fetal Diagn. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1111\/j.1447-0756.2007.00670.x","article-title":"First trimester ultrasound diagnosis of congenital diaphragmatic hernia","volume":"33","author":"Daskalakis","year":"2007","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.siny.2014.09.006","article-title":"Prenatalmanagementofthefetus with isolated congenital diaphragmatic hernia in the era of the TOTAL trial","volume":"19","author":"Deprest","year":"2014","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/PCC.0b013e31829b1e7a","article-title":"Right ventricular diastolic function measured by tissue doppler imaging predicts early outcome in congenital diaphragmatic hernia","volume":"15","author":"Moenkemeyer","year":"2014","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.jpeds.2018.07.062","article-title":"Early postnatal ventricular dysfunction is associated with disease severity in patients with congenital diaphragmatic hernia","volume":"203","author":"Patel","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jpeds.2018.02.040","article-title":"The Left Ventricle in Congenital Diaphragmatic Hernia: Implications for the Management of Pulmonary Hypertension","volume":"197","author":"Kinsella","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"151168","DOI":"10.1053\/j.semperi.2019.07.007","article-title":"Congenital diaphragmatic hernia-associated cardiac dysfunction","volume":"44","author":"Patel","year":"2020","journal-title":"Semin. Perinatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1097\/SLA.0000000000001675","article-title":"Fetal Tracheal Occlusion for Severe Pulmonary Hypoplasia in Isolated Congenital Diaphragmatic Hernia: A Systematic Review and Meta-analysis of Survival","volume":"264","author":"Eastwood","year":"2016","journal-title":"Ann. Surg."},{"key":"ref_16","first-page":"e86502","article-title":"Prenatal Interventions for Congenital Diaphragmatic Hernia: A Systematic Review","volume":"17","author":"Altala","year":"2025","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.21037\/tp-20-130","article-title":"Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: A narrative review of the history, current practice, and future directions","volume":"10","author":"Perrone","year":"2021","journal-title":"Transl. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/uog.4052","article-title":"Antenatal-CDH-Registry Group. Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia","volume":"30","author":"Jani","year":"2007","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1016\/j.ajog.2006.04.004","article-title":"Fetal lung-to-head ratio in the prediction of survival in severe left-sided diaphragmatic hernia treated by fetal endoscopic tracheal occlusion (FETO)","volume":"195","author":"Jani","year":"2006","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"560.e1","DOI":"10.1016\/j.ajog.2021.11.1351","article-title":"The randomized tracheal occlusion to accelerate lung growth (total)-trials on fetal surgery for congenital diaphragmatic hernia: Reanalysis using pooled data","volume":"226","author":"Benachi","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_21","first-page":"171","article-title":"Congenital diaphragmatic hernia in the neonate","volume":"5","author":"King","year":"2005","journal-title":"Contin. Educ. Anaesth. Crit. Care Pain"},{"key":"ref_22","first-page":"142","article-title":"Early outcome of congenital diaphragmatic hernia in a Malaysian tertiary centre","volume":"49","author":"Rohana","year":"2008","journal-title":"Singap. Med. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.jpedsurg.2004.02.010","article-title":"Factors influencing survival in newborns with congenital diaphragmatic hernia: The relative role of timing of surgery","volume":"39","author":"Rozmiarek","year":"2004","journal-title":"J. Pediatr. Surg."},{"key":"ref_24","first-page":"974041","article-title":"Congenital diaphragmatic hernia: Review of current concept in surgical management","volume":"2011","author":"Kesieme","year":"2011","journal-title":"Int. Sch. Res. Not."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000356437","article-title":"Left heart structures in human neonates with congenital diaphragmatic hernia and the effect of fetal endoscopic tracheal occlusion","volume":"35","author":"Rocha","year":"2014","journal-title":"Fetal Diagn. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1002\/uog.7340","article-title":"Left ventricular cardiac function in fetuses with congenital diaphragmatic hernia and the effect of fetal endoscopic tracheal occlusion","volume":"34","author":"Gucciardo","year":"2009","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1002\/pd.5333","article-title":"The impact of fetal endoscopic tracheal occlusion in isolated left-sided congenital diaphragmatic hernia on left-sided cardiac dimensions","volume":"38","author":"Dhillon","year":"2018","journal-title":"Prenat. Diagn."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1007\/s00246-024-03735-y","article-title":"Echocardiographic Changes in Infants with Severe Congenital Diaphragmatic Hernia After Fetoscopic Endoluminal Tracheal Occlusion (FETO)","volume":"47","author":"Avitabile","year":"2026","journal-title":"Pediatr. Cardiol."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/5\/813\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T05:50:13Z","timestamp":1779688213000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/5\/813"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["life16050813"],"URL":"https:\/\/doi.org\/10.3390\/life16050813","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]}}}