Cardiac Function in Fetuses with Congenital Diaphragmatic Hernia (CDH) Before and After Fetoscopic Endoluminal Tracheal Occlusion (FETO)-A Systematic Review.

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.