Thoracic Changes after Full Laser Ablation of the Feeding Artery in Fetuses with Bronchopulmonary Sequestration

Abstract

Objective: To assess longitudinal intrathoracic changes after fetal laser surgery in fetuses with bronchopulmonary sequestration (BPS) with hydrops and/or hydrothorax. Study Design: The presence of intrafetal fluid effusions, the lung mass volume ratio (congenital pulmonary airway malformation volume ratio [CVR]), and the observed/expected lung-to-head circumference ratio (O/E-LHR) of both lungs were evaluated in a cohort of BPS fetuses with hydrops and/or hydrothorax treated with full laser ablation of the feeding artery (FLAFA). The longitudinal changes in intrafetal fluid effusions, lung mass volume, and pulmonary growth were analyzed by survival and multilevel analysis against days after FLAFA. Results: FLAFA was successfully performed in 15 cases at a median gestational age of 26.9 weeks. A complete disappearance of the hydrops and hydrothorax was observed a median interval of 7.5 and 21 days after the fetal intervention, respectively. A progressive decrease in the CVR and an increment in the size of both lungs were observed after FLAFA. The O/E-LHR of the lung contralateral and ipsilateral to the side of the BPS became normal on average 8 and 10 weeks after FLAFA, respectively. Conclusion: Fetal laser surgery with FLAFA promotes disappearance of all fetal fluid effusions, a lung mass regression sequence, and a normalization of pulmonary growth.

Non-immune hydrops fetalis complicating bronchopulmonary sequestration: A case report

“…[9] In 2018, in a landmark paper, Cruz-Martinez et al reported full laser ablation of the feeding artery (FLAFA), successfully performed in 15 cases of BPS with pleural effusion/NIH. [8] They found that FLAFA causes the disappearance of all fetal effusions, regression of the sequestration, and normal pulmonary growth. In another longitudinal study in 2018, Riley et al reviewed 103 fetuses of BPS, four of that developed hydrops which were given maternal betamethasone; three fetuses underwent thoracentesis and/or thoracoamniotic shunt placement with subsequent hydrops resolution.…”

“…An extensive review of literature disclosed less than 80 published cases of BPS developing NIH which have survived after fetal therapy worldwide. [4,8,9] Cavaretto et al, in 2008 reviewed (in addition to their 8 cases) 31 cases of ELS with NIH published till 2008; these cases were treated with minimally invasive fetal therapy, and only 2 postnatal deaths were recorded confirming that fetal intervention in BPS with NIH positively improves the prognosis. [9] In 2018, in a landmark paper, Cruz-Martinez et al reported full laser ablation of the feeding artery (FLAFA), successfully performed in 15 cases of BPS with pleural effusion/NIH.…”

Intrauterine Ultrasound-Guided Laser Coagulation as a First Step for Treatment of Prenatally Complicated Bronchopulmonary Sequestration: Our Experience and Literature Review

“…Review of the literature identified 11 studies with original data of at least one case of BPS treated prenatally with USLC. 2,[12][13][14][15][16][17][18][19][20][21][22] Data on a total of 57 patients, including the five cases reported in the present series, were extrapolated and analyzed.…”

Cirugía fetal para hernia diafragmática congénita en América Latina

“…Estos cambios intrínsecos pueden ser evaluados clínicamente por ecografía Doppler del brazo proximal de la arteria intrapulmonar (figura 2). Nuestros estudios más recientes sugieren que la evaluación del Doppler intrapulmonar mejora notablemente la predicción del grado de hipoplasia pulmonar y la probabilidad de supervivencia neonatal (17) . Así, los casos con Doppler intrapulmonar patológico (flujo diastólico ausente o reverso) presentan una probabilidad de supervivencia neonatal de 30% comparada con 84% en aquellos casos con Doppler intrapulmonar normal, ausencia de herniación hepática y tamaño pulmonar mayor de 26%.…”