Fetal thoracoamniotic shunting as the only treatment for pulmonary sequestration with hydrops: favorable long‐term outcome without postnatal surgery

Salomon, Laurent; Audibert, François; Dommergues, Marc; Vial, M; Frydman, René

doi:10.1002/uog.76

Cited by 46 publications

(27 citation statements)

References 14 publications

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“…The most common interventions nowadays are pleuroamniotic shunting [4,5,13,14] and, more recently, the intrafetal percutaneous vascular laser ablation of the feeding vessel (VLA), as described above [4,5,8,[15][16][17]21]. While pleuroamniotic shunting only targets the symptoms of BPS and does not lead to a reduction in size, the incidence of postnatal surgery was high, with 87.5% of newborns requiring sequestrectomy [4,5,13,14].…”

Section: Discussionmentioning

confidence: 99%

“…In these cases, mortality and morbidity are considerably increased and prenatal treatment might be mandatory to avoid progression to hydrops, intrauterine death, and neonatal death due to pulmonary hypoplasia [4][5][6][7][8][9]. In the past, therapeutic approaches like inotropic therapy [10], fetal pleurodesis [11], fetal lobectomy [12], and even pleuroamniotic shunting [4,5,13,14] showed disappointing results and have been abandoned.…”

Section: Introductionmentioning

confidence: 99%

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

Gottschalk¹,

Strizek²,

Mallmann³

et al. 2017

Fetal Diagn Ther

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Objective: To assess the outcome of 12 fetuses with bronchopulmonary sequestration (BPS) and massive pleural effusion after intrafetal vascular laser ablation (VLA). Methods: All fetuses with BPS and massive pleural effusion that were treated with intrafetal VLA during a 5-year period (2012-2016) were reviewed for safety, intrauterine course, and postnatal outcome. Results: In the study period, 12 fetuses with BPS were treated with VLA. In 7 (58.3%) fetuses, complete cessation of blood flow was achieved after the first VLA, while in 5 (41.7%) fetuses, residual perfusion of the feeding vessel was demonstrated at follow-up. A second intervention was successful in 4 of 5 (80%) fetuses. Overall, in 11 of 12 (91.7%) fetuses, complete coagulation of the feeding vessel could be achieved, followed by a reduction in size or complete resolution of the BPS. All 11 fetuses with successful prenatal intervention were live-born at a median gestational age of 39⁺¹ (range, 37⁺⁵-41⁺²) weeks. Postnatally, 2 (18.2%) of the 11 newborns underwent sequestrectomy, as well as the preterm newborn on which a second fetal intervention was not feasible. Conclusion: VLA is an effective and safe treatment of BPS that appears to be of benefit in improving prognosis and decreasing the need for postnatal sequestrectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Gottschalk¹,

Strizek²,

Mallmann³

et al. 2017

Fetal Diagn Ther

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show abstract

“…The prognosis is poor in cases diagnosed before 26 weeks' gestation and is associated with mediastinal shift, polyhydramnios and fetal hydrops 4,5 . Prenatal management of complicated BPS has included treatment with direct fetal furosemide and digoxin therapy 6 , thoraco-amniotic shunting 7,8 and combined absolute alcohol injection into the feeding vessel and placement of a thoraco-amniotic shunt 9 . Open fetal surgery with resection of an extralobar BPS has also been reported 8 .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous ultrasound‐guided sclerotherapy for complicated fetal intralobar bronchopulmonary sequestration

Bermúdez

Pérez-Wulff

Bufalino

et al. 2007

Ultrasound in Obstet & Gyne

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“…Placement of a shunt did not decrease the ratio to ! 6 in cases 1-3. is known that a drainage procedure can reverse the hydrops [1,4,5] . We currently have no answer to the simple question of why one EPS produces massive pleural effusion leading to fetal hydrops while another EPS of the same size does not.…”

Section: Discussionmentioning

confidence: 99%

“…It is not difficult to detect aberrant venous flow around the aberrant artery if there is any flow. In the future, minimally invasive arterial occlusion [10] may become the definitive treatment for a fetus with EPS and massive pleural effusion, making the postnatal resection of EPS unnecessary [5,9,11] .…”

Section: Discussionmentioning

confidence: 99%

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

Kitano¹,

Sago

Hayashi

et al. 2008

Fetal Diagn Ther

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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.

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Fetal thoracoamniotic shunting as the only treatment for pulmonary sequestration with hydrops: favorable long‐term outcome without postnatal surgery

Abstract: Although it is established that bronchopulmonary seques-

Cited by 46 publications

References 14 publications

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

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

Percutaneous ultrasound‐guided sclerotherapy for complicated fetal intralobar bronchopulmonary sequestration

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

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