Minimally invasive fetal therapy for hydropic lung masses: three different approaches and review of the literature.

Détails

ID Serval
serval:BIB_8AEFA09A315E
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Minimally invasive fetal therapy for hydropic lung masses: three different approaches and review of the literature.
Périodique
Ultrasound in Obstetrics and Gynecology
Auteur(s)
Baud D., Windrim R., Kachura J.R., Jefferies A., Pantazi S., Shah P., Langer J.C., Forsey J., Chaturvedi R.R., Jaeggi E., Keating S., Chiu P., Ryan G.
ISSN
1469-0705 (Electronic)
ISSN-L
0960-7692
Statut éditorial
Publié
Date de publication
2013
Volume
42
Numéro
4
Pages
440-448
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish. pdf type: original paper
Résumé
OBJECTIVE: To report three different antenatal therapeutic approaches for fetal lung masses associated with hydrops.
METHODS: Three prospectively followed cases are described, and all 30 previously published minimally invasive cases of fetal therapy for hydropic lung masses are reviewed.
RESULTS: Three hydropic fetuses with large intrathoracic lung masses presented at 17, 25 and 21 weeks of gestation, respectively. An aortic feeding vessel was identified in each case and thus a bronchopulmonary sequestration (BPS) was suspected. Under ultrasound guidance, the feeding vessel was successfully occluded with interstitial laser (Case 1), radiofrequency ablation (RFA) (Case 2) and thrombogenic coil embolization (Case 3). Complete (Cases 1 and 2) or partial (Case 3) resolution of the lung mass and hydrops was observed. A healthy infant was born at term after laser therapy (Case 1), and the involved lung lobe was resected on day 2 of postnatal life. In Case 2, hydrops resolved completely following RFA, but an iatrogenic congenital diaphragmatic hernia and abdominal wall defect became apparent 4 weeks later. The neonate died from sepsis following spontaneous preterm labor at 33 weeks. In Case 3, despite technical success in complete vascular occlusion with coils, a stillbirth ensued 2 days after embolization.
CONCLUSIONS: The prognosis of large microcystic or echogenic fetal chest masses associated with hydrops is dismal. This has prompted attempts at treatment by open fetal surgery, with mixed results, high risk of premature labor and consequences for future pregnancies. We have demonstrated the possibility of improved outcome following ultrasound-guided laser ablation of the systemic arterial supply. Despite technical success, RFA and coil embolization led to procedure-related complications and need further evaluation.
Pubmed
Web of science
Open Access
Oui
Création de la notice
28/01/2014 16:39
Dernière modification de la notice
20/08/2019 15:49
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