Thoracoamniotic Shunting with Double-Basket Catheters for Fetal Chylothorax in the Second Trimester

Abstract

The progress of a fetal severe pleural effusion at mid-trimester is extremely poor. We encountered a fetus that developed a severe left pleural effusion at 21 weeks of gestation. The pleural effusion was removed by thoracocentesis at 22 weeks. Cytology revealed abundant lymphocytes, suggesting chylothorax. However, a reaccumulation of pleural effusion with hydrops was subsequently noted, and a thoracoamniotic shunt with double-basket catheters was installed at 23 weeks. The pleural effusion decreased after 24 weeks and completely disappeared at 26 weeks. At 40 weeks of gestation, a female infant was born by vaginal delivery, with no evidence of pleural effusion. We would like to stress that thoracoamniotic shunt with double-basket catheters in the second trimester is effective for pleural effusion with hydrops.

The prognostic factors and outcomes of primary fetal hydrothorax with the effects of fetal intervention

“…The criteria for TAS were reaccumulation to the previous level of pleural effusion within 7 days after initial TC in hydrops fetuses or in non‐hydropic fetuses with massive pleural effusion occupying more than half of the fetal chest cavity when the gestational ages were between 18 weeks 0 days and 33 weeks 6 days . A double‐basket catheter (Hakko Co. Nagano, Japan) was used to perform TAS. Repetitive TC was used when it was judged to be difficult to perform TAS safely.…”

Retrospective Review of Thoracoamniotic Shunting Using a Double-Basket Catheter for Fetal Chylothorax

“…In Japan, however, only the double-basket catheter is approved as a treatment for fetal chylothorax. There are few reports of this device [13,14]. …”

The outcomes and prognostic factors of fetal hydrothorax associated with trisomy 21

“…The criteria for TAS were reaccumulation of pleural effusion to the previous level within 7 days after initial TC in hydropic fetuses or in nonhydropic fetuses with massive pleural effusion occupying more than half of the effusion side of the fetal chest cavity for gestational ages between 18w0d and 33w6d . The double‐basket catheter (Hakko Co., Nagano, Japan) was used for TAS in all cases. Repetitive TC was performed when it was judged to be difficult to perform TAS safely.…”