Endotracheal Balloon Bursting: Modified Technique for Percutaneous Ultrasound-Guided Balloon Puncture to Reverse Tracheal Occlusion in Congenital Diaphragmatic Hernia.

Abstract

Introduction: Fetuses with congenital diaphragmatic hernia (CDH) treated with fetal endoscopic tracheal occlusion (FETO) require a second procedure to reverse tracheal occlusion before birth. In this study, we aimed to report the feasibility and perinatal outcomes of a modified technique for ultrasound-guided balloon bursting used as a primary attempt.

Methods: From January 2012 to December 2025 a prospective cohort of isolated CDH cases treated with FETO was included in a management protocol for balloon removal by a percutaneous balloon bursting using a 22-gauge needle in a transversal view of the fetal trachea under simultaneous 2D and color Doppler ultrasound guidance (dual imaging) to avoid vessels. The feasibility of this technique, procedure-related characteristics, complications, and outcomes were evaluated.

Results: During the study period, 88 (74 left-sided, and 14 right-sided) CDH were treated with FETO at a mean GA of 29.6 weeks. The balloon was removed at a mean GA of 33.8 weeks and as an emergency procedure in up to 40.7% of the cases. Percutaneous ultrasound-guided balloon puncture was feasible in 80% of the cases. Our technique was technically successful and allowed balloon rupture in up to 98.5% of the selected cases. No cases of fetal bleeding or intrauterine fetal demise after balloon removal were observed and, in all cases, a patent airway was confirmed after birth.

Conclusion: Implementing a modified technique for percutaneous ultrasound-guided balloon bursting is safe and feasible and allows balloon rupture, avoiding the need for a second fetoscopic procedure for the reversal of FETO.