Aberrant Venous Flow Measurement May Predict the Clinical Behavior of a Fetal Extralobar Pulmonary Sequestration

Abstract

Objective: Fetal extralobar pulmonary sequestration (EPS) is sometimes complicated by a massive pleural effusion, leading to tension hydrothorax and fetal hydrops. The goal of this study was to examine sonographic signs of venous obstruction in fetal EPS with or without pleural effusion. Methods: Records of fetal ultrasound from 6 patients with EPS were reviewed with special attention to aberrant arterial and venous flow. The results were correlated with their clinical outcomes. Results: Four of the 6 cases (cases 1–4) were complicated by massive pleural effusion and required fetal thoracentesis; thoracoamniotic shunt placement was required in 3 of these 4 patients (cases 1–3). The other 2 patients (cases 5 and 6) were not associated with pleural effusion despite the comparable size of the mass and did not require any treatment, either prenatally or postnatally. In cases 1–3, aberrant venous flow was difficult to detect and, even when detected, the arterial-to-venous flow velocity ratio was >6. This is in contrast to the uncomplicated cases 5 and 6 in whom aberrant venous flow was easily detected with an arterial-to-venous flow velocity ratio of 2–3. Arterial-to-venous flow velocity ratios of 3–6 were observed in case 4. This case was complicated by pleural effusion but not by fetal hydrops. Conclusions: These data support the hypothesis that venous obstruction is related to the production of pleural effusion in fetal EPS. Ample flow in the aberrant vein may indicate benign clinical behavior, while difficulty in detecting aberrant venous flow may be correlated with the development of massive pleural effusion.

Outcome of Bronchopulmonary Sequestration with Massive Pleural Effusion after Intrafetal Vascular Laser Ablation

“…This arterial blood supply typically originates from the descending aorta or, rarely, from intercostal, gastric, or splenic arteries. Venous drainage can be systemic or pulmonary [1][2][3].…”

Systemic Venous Drainage Is Associated with an Unfavorable Prenatal Behavior in Fetal Bronchopulmonary Sequestration

“…Zhang et al [9] found that BPS fetuses with a CVR >1.6 were prone to have fetal hydrops. Kitano et al [7, 8] found that obstruction of the drainage vein, manifested as a decrease in blood flow assessed by Doppler ultrasound, was associated with massive pleural effusion, though a large sample size is required to confirm their findings. Our study, which recruited a larger FBS cohort, showed that BPSs with SVD were more frequently complicated by hydrops and polyhydramnios than those with PVD, although the CVRs of the two groups did not differ from each other.…”

“…Although the prognosis of the majority of cases is favorable, there are still some cases that develop hydrops and pulmonary hypoplasia, which can result in high intrauterine and neonatal mortality [3-6]. However, few factors have so far been found to correlate with different prenatal course and outcomes [7-9]. Kitano et al [7] were the first to apply assessment of the venous blood flow in BPS to predict clinical outcomes.…”

“…However, few factors have so far been found to correlate with different prenatal course and outcomes [7-9]. Kitano et al [7] were the first to apply assessment of the venous blood flow in BPS to predict clinical outcomes. They found that a decrease in blood flow in the drainage vein was associated with hydrops in extralobar pulmonary sequestration (EPS), and therefore highlighted the importance of venous drainage assessment in the evaluation of fetuses with BPS.…”

Secuestro pulmonar en embarazo gemelar monocorial-biamniótico

“…P Velásquez Trujillo, et al 2016; 11 (supl): 78-81 una arteria sistémica separada, suministro arterial originado típicamente a partir de la aorta descendente y ocasionalmente desde la intercostal, celíaca o arterias esplénicas, mientras que el drenaje venoso es a través de las venas ácigos o la vena cava inferior y venas pulmonares 1 . Aunque 70% tienen regresión espontánea in-utero, puede progresar en el período intrauterino y solo unos pocos casos se asocian con un rápido crecimiento y/o derrame pleural e hidrops fetal (mortalidad entre 90% y 100%) 2 , secundarios a torsión de la masa con alteración u obstrucción del sistema linfático o venoso, volviéndose insuficiente, requiriendo tratamiento intrauterino, caracterizado por oclusión arterial mínimamente invasiva, a partir de cirugía fetal con toracotomía y secuestrectomía 3 , ablación arterial por fotocoagulación o inyección de sustancias esclerosantes o ablación por radiofrecuencia, convirtiéndose en tratamiento definitivo siendo innecesaria la resección postnatal 4 .…”