31 01, 2019

SUCCESSFUL IN UTERO TRANSESOPHAGEAL PACING FOR SEVERE DRUG-RESISTANT TACHYARRHYTHMIA

By | 2019-08-31T10:40:07+00:00 31 janvier, 2019|Categories: CHIRURGIE FOETALE|Tags: , , |0 Comments

Successful in utero transesophageal pacing for severe drug-resistant tachyarrhythmia
Stirnemann, Julien et al.
American Journal of Obstetrics & Gynecology , Volume 219 , Issue 4 , 320 – 325

Sustained fetal tachyarrhythmia can evolve into a life-threatening condition in 40% of cases when hydrops develops, with a 27% risk of perinatal death. Several antiarrhythmic drugs can be given solely or in combination to the mother to achieve therapeutic transplacental concentrations. Therapeutic failure could lead to progressive cardiac insufficiency and restrict therapeutic options to either elective delivery or direct fetal administration of antiarrhythmic drugs, which may increase the risk of death. We report for the first time successful fetal transesophageal pacing to treat a hydropic fetus with drug-resistant tachyarrhythmia.

 

31 08, 2018

PRETERM PREMATURE RUPTURE OF MEMBRANES IS A COLLATERAL EFFECT OF IMPROVEMENT IN PERINATAL OUTCOMES FOLLOWING FETOSCOPIC COAGULATION OF CHORIONIC VESSELS FOR TWIN-TWIN TRANSFUSION SYNDROME: A RETROSPECTIVE OBSERVATIONAL STUDY OF 1092 CASES

By | 2018-09-01T09:48:47+00:00 31 août, 2018|Categories: CHIRURGIE FOETALE|Tags: , , , |0 Comments

Preterm premature rupture of membranes is a collateral effect of improvement in perinatal outcomes following fetoscopic coagulation of chorionic vessels for twin-twin transfusion syndrome: a retrospective observational study of 1092 cases

J Stirnemann, F Djaafri, A Kim, Mediouni, L Bussieres, E Spaggiari, C Veluppillai, A Lapillonne, E Kermorvant, J·F Magny, C Colmant, Y Ville

BJOG https://doi.org/10.1111/1471-0528.15147

Preterm premature rupture of membranes (PPROM) is a leading complication following fetoscop ic laser coagulation (FLC) for twin-twi n transfusion syndrome (TTTS). Our primary objective was to describe the impact of improvements in surgical technique on survival and rate of PPROM over time .. The secondary objective was to assess potential risk factors for PPROM.

 

4 07, 2018

HISTOPATHOLOGIE DES MYÉLOMÉNINGOCÈLES : L’ALTÉRATION DES MOTONEURONES EST MASSIVE ET PRÉCOCE

By | 2019-02-04T13:58:05+00:00 4 juillet, 2018|Categories: CHIRURGIE FOETALE, IMAGERIE|Tags: , , , , |Commentaires fermés sur HISTOPATHOLOGIE DES MYÉLOMÉNINGOCÈLES : L’ALTÉRATION DES MOTONEURONES EST MASSIVE ET PRÉCOCE

NATURE AND TIMING OF SPINAL CORD INJURY IN MMC: A POST-MORTEM ASSESSMENT THROUGHOUT GESTATION.

S. BEN MILED , F. RAZAVI, L. LOEUILLET, S JAMES, B. LEROY, B BESSIERES, Y. VILLE, T. ATTIE BITACH, J. STIRNEMANN

L’objectif de ce projet est l’étude des altérations médullaires au niveau neuronal des myéloméningocèles (MMC) et leur évolution avec l’âge du foetus dans une des plus grandes populations de foetus post-mortem, entre 13 et 39 semaines d’aménorrhée. Ces travaux, conduits par S. Ben Miled, F. Razavi, L. Loeuillet sous la direction de Julien Stirnemann, ont fait l’objet d’une communication le 24 Juin 2018 lors du 17em FMF World Congress à Athènes.

Les premiers résultats de ce travail apportent la preuve que des altérations motoneuronales peuvent être observées très tôt dans la grossesse, dès 13 semaines, contre-disant la théorie habituellement reconnue d’une altération progressive et plus tardive liée à la toxicité de l’environnement intra-utérin pour la moelle exposée. En effet, déjà à ce terme précoce, la perte de motoneurones est massive, aggravée de multiples altérations histologiques au niveau cellulaire. Celles-ci s’observent non seulement à hauteur de la lésion mais atteignent également la moelle d’amont. Par ailleurs, la perte de motoneurones se fait de plus en plus marquée avec le terme de la grossesse.

Ces résultats de ces travaux auront un impact énorme sur la comprehension de l’histoire naturelle ainsi que le rationnel, les bénéfices attendus et les méthodes employées pour le traitement prénatal de cette affection.

Evolution des principaux marqueurs de gravité des myéloméningocèles lombo-sacrées:

Pertes précoce de motoneurones :

 

Neu N est un immunomarquage de Motoneurones alpha FONCTIONNELS
ici colorés en marron sur le témoin et absents sur le spina

 

2 07, 2018

THE LEGAL FRAMEWORKS THAT GOVERN FETAL SURGERY IN THE UNITED KINGDOM, EUROPEAN UNION, AND THE UNITED STATES

By | 2018-07-02T21:17:58+00:00 2 juillet, 2018|Categories: CHIRURGIE FOETALE|Commentaires fermés sur THE LEGAL FRAMEWORKS THAT GOVERN FETAL SURGERY IN THE UNITED KINGDOM, EUROPEAN UNION, AND THE UNITED STATES

Cao KX, Booth A, Ourselin S, David AL, Ashcroft R. The legal frameworks that govern fetal surgery in the United Kingdom, European Union, and the United States. Prenatal Diagnosis. 2018;38:475–481. https://doi.org/10.1002/pd.5267

The specialty of fetal surgery or fetal intervention is one of the most exciting emerging fields of modern medicine. It is made possible by decades of major developments in antenatal imaging, obstetric anaesthesia, fetal medicine, paediatric surgery, and of course by the bold and novel practitioners willing to take new steps to advance the field. Beginning in the 1970s, it has now reached a stage of maturity where there are several established in utero procedures and countless clinical trials and studies to develop more. But what is the legal situation that fetal surgeons find themselves in? What are the rights and legal protections for the fetus and the mother, both of which are arguably the patient? This article will address this question, discussing and summarising the current legal frameworks governing fetal surgery in the jurisdictions of the United Kingdom, European Court of Human Rights, and the United States of America as well as discuss what the future may hold and how researchers and physicians in the specialty can best navigate the legal environment.

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30 05, 2018

GROUNDBREAKING IN-UTERO SPINA BIFIDA SURGERY HAILED A SUCCESS

By | 2018-05-30T21:33:34+00:00 30 mai, 2018|Categories: CHIRURGIE FOETALE|Tags: |Commentaires fermés sur GROUNDBREAKING IN-UTERO SPINA BIFIDA SURGERY HAILED A SUCCESS

For most parents, witnessing their baby’s first steps is a moment of great excitement. But when Claudine and Dave Fitzgibbon’s son Harvey first walked, their dominant emotion was relief.

“Seeing him get up and take those first few steps was quite amazing,” says Dave who, with his wife, endured years of trauma in the hope of giving their five-year-old daughter, Eliza, a sibling.

In August 2016, a team of medical specialists at the Mater Mothers’ Hospital in Brisbane performed groundbreaking surgery on Harvey while he was still in the womb to correct a defect caused by spina bifida.

His parents were told Harvey might never be able to walk.

 

Now, more than a year and a half since the risky operation, and a year since Australian Story first met the couple, they are quietly watching their happy little boy meet milestones. “As he progressed, it was like tick, tick, tick, tick, tick, tick,” Dave says. “Bowel, bladder, brain, ventricles, legs, feet, muscle tone, so it was just a huge amount of relief.”

Harvey took his first steps in March, a few months after his first birthday.

http://www.abc.net.au/news/2018-05-07/groundbreaking-spina-bifida-surgery-a-success-one-year-on/9722676