Thoracoamniotic Shunts in Macrocystic Lung Lesions: Case Series and Review of the Literature.

Abstract

OBJECTIVE:

To evaluate the efficiency of thoracoamniotic shunts for drainage of macrocystic-type congenital cystic adenomatoid malformation (CCAM).

SUBJECTS AND METHODS:

This was a retrospective study of 12 fetuses with a large thoracic cyst treated with thoracoamniotic shunting between 2004 and 2014 in a tertiary fetal therapy center. Medline was searched to identify cases of CCAM treated with thoracoamniotic shunting.

RESULTS:

In all cases the thoracic cyst was associated with major mediastinal shift, the CCAM volume ratio (CVR) was >1.6, and in eight cases there was associated hydrops. Shunt insertion was successfully carried out in all cases at a median gestational age of 24 weeks (range 18-34). In 10 cases there was live birth at a median age of 38 weeks (range 35-41), but in two hydropic fetuses there was intrauterine death. A literature search identified a total of 98 fetuses with CCAM treated with thoracoamniotic shunting between 1987 and 2016. In the combined data from the previous and the current study, the survival rate was 77% (53 of 69) for hydropic and 90% (37 of 41) for nonhydropic fetuses.

CONCLUSIONS:

The role of thoracoamniotic shunting in macrocystic lung lesions associated with hydrops is well accepted. Intrauterine intervention is also likely to be beneficial in the subgroup of nonhydropic fetuses with a CVR >1.6.

• Authors: Magdalena Litwińska, Ewelina Litwińska, Katarzyna Janiak, Anna Piaseczna-Piotrowska, Ewa Gulczyńska, Krzysztof Szaflik
• Journal: Fetal diagnosis and therapy (Fetal Diagn Ther) Vol. 41 Issue 3 Pg. 179-183 ( 2017) ISSN: 1421-9964 [Electronic] Switzerland
• PMID: 27489957 (Publication Type: Journal Article, Review)
• Copyright: © 2016 S. Karger AG, Basel.

Topics

• Catheterization (instrumentation, methods)
• Cystic Adenomatoid Malformation of Lung, Congenital (diagnostic imaging, surgery)
• Female
• Humans
• Pregnancy
• Retrospective Studies
• Thoracotomy (instrumentation, methods)
• Ultrasonography, Prenatal (methods)