Thoracoscopy-assisted removal of a thoracoamniotic shunt double-basket catheter dislodged into the fetal thoracic cavity: report of three cases

Abstract

The indications for and timing of surgical removal of a dislodged thoracoamniotic shunt double-basket catheter are not established, and the side effects of the dislodged into the thoracic cavity remain controversial. The double-basket catheter was designed to reduce the incidence of catheter dislodgement; however, we have encountered four cases of thoracoamniotic shunt double-basket catheter dislodgement into the fetal thorax. The dislodged shunt catheters were removed safely with thoracoscopic assistance within several days of birth, when additional treatments for pleural effusion were needed, such as thoracic drainage tube insertion and adhesion treatment of the thorax. We report the clinical courses of three of these cases of thoracoamniotic shunt tube dislocation. By waiting several days postnatally for stabilization of respiratory and circulatory status and the effective use of thoracoscopic assistance, the dislodged catheter was safely removed from the neonatal thorax. The accumulation of case reports will help establish suitable treatments, and their indication, for a dislodged thoracoamniotic shunt catheter within the fetal thoracic cavity.

Ultrasound-Guided Retrieval and Position Replacement of a Dislodged Fetal Pleuro-Amniotic Shunt: A Novel Approach for a Known Complication of Feto-Amniotic Shunting

“…Internalization of the pleuro-amniotic shunt into the fetal thorax has been reported at a rate of up to 20% [2,4]. Different management strategies of intrathoracic shunt displacement have been described in the literature.…”

“…Neonatal removal of dislodged shunts has been suggested when infants require chest tube drainage because of persistent pleural effusions. Inoue et al [4] reported 3 cases of thoracostomy-assisted removal of the shunts from the neonates who required chest tube drainage.…”

“…When pleural effusions have been reported to reaccumulate after shunt dislodgement, the management reported has been to place a second or even third shunt [4]. Fetal removal of an intrathoracic shunt is ideal as developmental complications due to the presence of the shunt have been reported.…”

“…Large amounts of pleural fluid can compress the lung and heart and lead to abnormal lung development, fetal hydrops, and even fetal death. Pleuro-amniotic shunting has been utilized to improve perinatal outcomes [1,2,3,4,5]. However, the procedure is not without risks.…”

“…However, the procedure is not without risks. Known complications of shunting include ruptured membranes, preterm labor, shunt malfunction due to blockage, and shunt dislodgement both into the amniotic cavity and the fetal thorax [1,2,3,4,5]. …”