Endoscopic laser coagulation of feeding vessels in large placental chorioangiomas: report of three cases and review of invasive treatment options

Sepúlveda, Waldo; Wong, Amy E.; Herrera, Lenín; Dezerega, Víctor; Devoto, Juan C.

doi:10.1002/pd.2197

Cited by 111 publications

(60 citation statements)

References 24 publications

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“…However, in both cases, preterm labor and neonatal death followed, although a definite association to the procedure is difficult to make. Laser photocoagulation has been reported with the most success in cases using an ultrasound-guided interstitial approach [5,18] or the fetoscope [5,8,11,19,20]. In 1 of the cases of ultrasound guidance alone, revascularization and recurrent HCOS necessitated reapplication of the laser process [18].…”

Section: Discussionmentioning

confidence: 99%

Giant Chorioangiomas: Perinatal Outcomes and Techniques in Fetoscopic Devascularization

Lim¹,

Coleman²,

Polzin³

et al. 2014

Fetal Diagn Ther

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Objective: To evaluate the intrauterine management and perinatal outcome of pregnancies complicated by giant placental chorioangioma (>4 cm) and elaborate on various devascularization techniques. Materials and Methods: Retrospective review of 10 cases of giant placental chorioangioma evaluated between January 2005 and August 2012. Maternal demographics, prenatal imaging, response to fetoscopic treatment, obstetrical complications, and perinatal outcomes were evaluated. Results: Overall survival was 80%. Seven (70%) cases were associated with obstetrical complications, including polyhydramnios (n = 7), non-immune hydrops (n = 3), and high cardiac output state (n = 5). Five patients underwent fetoscopic devascularization at a mean gestational age of 24.03 weeks with 80% survival. The tumors were devascularized by bipolar coagulation (n = 1), combination of bipolar and diode laser (n = 2), bipolar and radiofrequency ablation (n = 1), and surgical clip application (n = 1). Postoperatively, all survivors had resolution of hydrops and high cardiac output states with survival beyond 60 days of life. Discussion: Fetoscopic devascularization is indicated for high cardiac output states or non-immune hydrops and may require multiple techniques including bipolar coagulation, clip application, and/or laser to interrupt arterial inflow and devascularize the mass.

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Section: Discussionmentioning

confidence: 99%

Giant Chorioangiomas: Perinatal Outcomes and Techniques in Fetoscopic Devascularization

Lim¹,

Coleman²,

Polzin³

et al. 2014

Fetal Diagn Ther

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“…El nivel de complejidad fue aumentando con procedimientos como ablación de vasos placentarios con laser o con embolización de malformaciones congénitas adenomatoides quísticas pulmonares y luego en inserción de shunts en obstrucciones urinarias bajas 12,13,14,15,16,17 . Finalmente la experiencia adquirida a lo largo de este proceso es lo que ha permitido poder realizar la neurorrafia prenatal del MMC.…”

Section: Cirugía Fetal En Chileunclassified

Untitled

2017

Rev Chil Anest

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AntecedentesLa administración de anestesia para la reparación prenatal del mielomeningocele revela condiciones que están ligadas a esta nueva forma de tratamiento: el bienestar fetal, el contexto quirúr-gico y la perfusión uterina.La descripción, el análisis y la comprensión de las distintas variables que están involucradas permitirá disminuir el elevado riesgo que carga esta cirugía.Objetivo: Esta revisión entrega un enfoque sistemático a los nuevos desafíos que plantea la cirugía fetal. IntroducciónEl estudio comparativo sobre el manejo del mielomeningocele (MMC), tan apropiadamente llamado "MOMS" (Management of myelomeningocele study, por su sigla en inglés), fue publicado por primera vez en el New England Journal of Medicine en Marzo 2011 1 . Los hallazgos de este estudio demuestran los beneficios del tratamiento prenatal y sus conclusiones desplazan las fronteras del conocimiento más allá de los convencionales paradigmas de la terapia en Medicina y abren las puertas a un nuevo desafío para los Anestesiólogos: La Cirugía Fetal.Así como la descripción de Vandam 2 sobre las consideraciones anestésicas para el trasplante renal o la de Aldrete 3 en el trasplante hepáti-co o la reciente publicación de Klein 4 sobre las implicancias anestesiológicas en la inserción de la válvula aortica por cateterismo, el trabajo de Adzick 1 da inicio a una nueva era en el desarrollo de la anestesiología donde deberemos contestar preguntas que no nos habíamos formulado y donde deberemos profundizar en áreas que esta emergente técnica nos obligará a desarrollar.Esta publicación esta basada en la experiencia adquirida en los primeros 29 casos realizados en Chile. Se describen los defectos del tubo neural y se analizan las principales variables a considerar:• El dolor fetal.• La técnica anestésica.• La monitorización.• La relajación uterina.• La reposición de fluidos. Epidemiología de los defectos del tubo neuralEn Chile ocurren alrededor de 250.000 nacimientos por año, con una tasa de natalidad de

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“…Alternatives are embolization of the vascular plexus, either by alcohol or coils. The condition is too rare to reasonably assess as to which is the best technique [123][124][125][126][127].…”

Section: Uncommon Fetoscopic Interventionsmentioning

confidence: 99%

The use of endoscopy in fetal medicine

Beck¹,

Pexsters²,

Gucciardo³

et al. 2010

Gynecol Surg

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We aimed to review the state of affairs in the field of embryo-fetoscopy as well as its instrumental requirements. Today, endoscopic procedures of limited complexity are easily possible within the amniotic cavity. Embryoscopy is typically done for diagnostic purposes, such as the demonstration of external anomalies very early in pregnancy and/or obtaining embryonic tissues in recurrent miscarriages. Fetoscopy is the direct visualization of the amniotic cavity from the second trimester onwards. Its principal indications are complications of monochorionic twinning and severe congenital diaphragmatic hernia. There is level I evidence that fetoscopic laser surgery for twintwin-transfusion syndrome is superior over amniodrainage. Fetoscopic endoluminal tracheal occlusion is done for severe diaphragmatic hernia. Whether tracheal occlusion yields better outcomes than expectant management during pregnancies is currently being investigated in a randomized trial. There are a number of less common procedures discussed as well. Overall, maternal risks of embryofetoscopy are minimal. The most frequent complication is rupture of the membranes and as a consequence preterm delivery. Fetal surgery seems safe and has, therefore, become a clinical reality. Although the stage of technical experimentation is over, most interventions remain investigational. Inclusion of patients into trials whenever possible should be encouraged, rather than building up casuistic experience.

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Endoscopic laser coagulation of feeding vessels in large placental chorioangiomas: report of three cases and review of invasive treatment options

Cited by 111 publications

References 24 publications

Giant Chorioangiomas: Perinatal Outcomes and Techniques in Fetoscopic Devascularization

Giant Chorioangiomas: Perinatal Outcomes and Techniques in Fetoscopic Devascularization

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The use of endoscopy in fetal medicine

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